FERTILITY OPTIONS AFTER VASECTOMY - A COST-EFFECTIVENESS ANALYSIS

Objective: To evaluate cost per delivery using two different initial a pproaches to the treatment of postvasectomy infertility. Design: Model of expected costs and results in the United States in 1994. Setting: Men with postvasectomy infertility, evaluated and treated at centers w ith experience in vasectomy reversal or sperm retrieval and ICSI. Pati ent(s): Men with postvasectomy infertility, with a female partner less than or equal to 39 years of age. Intervention(s): Initial microsurgi cal vasectomy reversal was compared with retrieved epididymal or testi cular sperm. Actual treatment charges, complication rates, and pregnan cy and delivery rates obtained in the United States were used for cost per delivery analysis. Main Outcome Measure(s): Cost per delivery, de livery rates. Result(s): Cost per delivery with an initial approach of vasectomy reversal was only $25,475. (95% confidence interval $19,609 to $31,339), with a delivery rate of 47%. However, the cost per deliv ery after sperm retrieval and ICSI was $72,521. (95% confidence interv al $63,357 to $81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. The delivery rate after one cycle of sperm retrieval and IC SI was 33%. Conclusion(s): The most cost-effective approach to treatme nt of postvasectomy infertility is microsurgical vasectomy reversal. T his treatment also has the highest chance of resulting in delivery of a child for a single intervention.