Cost-effectiveness of tubal patency tests

H. R. Verhoeve, L. M. Moolenaar, P. Hompes, F. Van Der Veen, B. W J Mol

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Design Cost-effectiveness analysis. Setting Decision analytic framework. Population Computer-simulated cohort of subfertile women. Methods We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Main outcome measures Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. Results For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. Conclusions The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.

LanguageEnglish
Pages583-593
Number of pages11
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume120
Issue number5
DOIs
Publication statusPublished - 1 Apr 2013

Keywords

  • HSG
  • cost-effectiveness
  • in vitro fertilisation
  • laparoscopy
  • tubal pathology

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Verhoeve, H. R., Moolenaar, L. M., Hompes, P., Van Der Veen, F., & Mol, B. W. J. (2013). Cost-effectiveness of tubal patency tests. BJOG: An International Journal of Obstetrics and Gynaecology, 120(5), 583-593. https://doi.org/10.1111/1471-0528.12121
Verhoeve, H. R. ; Moolenaar, L. M. ; Hompes, P. ; Van Der Veen, F. ; Mol, B. W J. / Cost-effectiveness of tubal patency tests. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2013 ; Vol. 120, No. 5. pp. 583-593.
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abstract = "Objective Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Design Cost-effectiveness analysis. Setting Decision analytic framework. Population Computer-simulated cohort of subfertile women. Methods We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Main outcome measures Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. Results For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4{\%}, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. Conclusions The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.",
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Verhoeve, HR, Moolenaar, LM, Hompes, P, Van Der Veen, F & Mol, BWJ 2013, 'Cost-effectiveness of tubal patency tests', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 120, no. 5, pp. 583-593. https://doi.org/10.1111/1471-0528.12121

Cost-effectiveness of tubal patency tests. / Verhoeve, H. R.; Moolenaar, L. M.; Hompes, P.; Van Der Veen, F.; Mol, B. W J.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 120, No. 5, 01.04.2013, p. 583-593.

Research output: Contribution to journalArticle

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AU - Moolenaar, L. M.

AU - Hompes, P.

AU - Van Der Veen, F.

AU - Mol, B. W J

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N2 - Objective Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Design Cost-effectiveness analysis. Setting Decision analytic framework. Population Computer-simulated cohort of subfertile women. Methods We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Main outcome measures Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. Results For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. Conclusions The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.

AB - Objective Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Design Cost-effectiveness analysis. Setting Decision analytic framework. Population Computer-simulated cohort of subfertile women. Methods We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Main outcome measures Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. Results For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. Conclusions The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.

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KW - cost-effectiveness

KW - in vitro fertilisation

KW - laparoscopy

KW - tubal pathology

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