Management of the first in vitro fertilization cycle for unexplained infertility cost effectiveness analysis of split in vitro fertilization intracytoplasmic sperm injection

Capsule:
Conventional IVF may be the preferred insemination method in the initial treatment of couples with unexplained infertility, but split IVF-ICSI becomes preferable if more than one IVF cycle is necessary.

Authors:
Wendy Vitek, M.D., Omar Galarraga, Ph.D., Peter C. Klatsky, M.D., M.P.H., Jared C. Robins, M.D., Sandra A. Carson, M.D., Andrew S. Blazar, M.D.

Volume 100, Issue 5, Pages 1381-1388.e1, November 2013

Abstract:

Objective:
To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility.

Design:
Adaptive decision model.

Setting:
Academic infertility clinic.

Patient(s):
A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. Intervention(s):
Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes.

Main Outcome Measure(s):
Live birth rate, incremental cost-effectiveness ratio (ICER).

Result(s):
In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666.

Conclusion(s):
In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.

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