Cost effectiveness analysis comparing continuation of assisted reproductive technology with conversion to intrauterine insemination in patients with low follicle numbers

Capsule:
In patients with 4 mature follicles during controlled ovarian stimulation, it is more cost effective to proceed with oocyte retrieval than to convert to intrauterine insemination.

Authors:
Bo Yu, M.D., Sunni Mumford, Ph.D., G. Donald Royster IV, M.D., James H. Segars, M.D., Alicia Y. Armstrong, M.D.

Volume 102, Issue 2, Pages 435–439

Abstract:

Objective:
To compare the cost effectiveness of proceeding with oocyte retrieval vs. converting to intrauterine insemination (IUI) in patients with ≤4 mature follicles during assisted reproductive technology (ART) cycles.

Design:
Probabilistic decision analysis. The cost effectiveness of completing ART cycles in poor responders was compared to that for converting the cycles to IUI.

Setting:
Not applicable.

Patient(s):
Not applicable.

Intervention(s):
Cost-effectiveness analysis.

Main Outcome Measure(s):
Cost effectiveness, which was defined as the average direct medical costs per ongoing pregnancy.

Result(s):
In patients with 1–3 mature follicles, completing ART was more cost effective if the cost of a single ART cycle was between $10,000 and $25,000. For patients with 4 mature follicles, if an ART cycle cost <$18,025, it was more cost effective to continue with oocyte retrieval than to convert to IUI. Conclusion(s):
In patients with ≤4 mature follicles following ovarian stimulation in ART cycles, it was on average more cost effective to proceed with oocyte retrieval rather than convert to IUI. However, important factors, such as age, prior ART failures, other fertility factors, and medications used in each individual case need to be considered before this analysis model can be adapted by individual practices.

  • Lauren Johnson

    I congratulate Dr. Yu and colleagues on this well-done cost-effectiveness analysis! The assumptions that were included in the model are data driven, and constructing the model from a patient perspective makes this model particularly useful. This paper is a nice compliment to the manuscript by Reichman and colleagues last year that demonstrated higher pregnancy and live birth rates with IVF compared to IUI for those with two or three follicles.

    I do have a question for the authors. As you mention in the manuscript, the model does not include patient age, mainly because the papers used to create the model do not include estimates of pregnancy outcomes broken down by patient age. Were you able to calculate the mean age overall for the cohort of patients used to generate the model? If so, please share it here as I think that would be very helpful!

    Again, congratulations!

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