COST-EFFECTIVENESS OF INFERTILITY TREATMENTS - A COHORT STUDY

Objective: To determine the cost-effectiveness of infertility treatmen ts. Design: Retrospective cohort study. Setting: Academic medical cent er infertility practice. Patient(s): All patients treated for infertil ity in a 1-year time span. Intervention(s): Intrauterine inseminations , clomiphene citrate and IUI(CC-IUI), hMG and IUI (hMG-IUI), assisted reproductive techniques (ART), and neosalpingostomy by laparotomy. Mai n Outcome Measure(s): All medical charges and pregnancy outcomes assoc iated with the treatments were obtained. Cost-effectiveness ratios def ined as cost per delivery were determined for each procedure. The effe cts of a woman's age and the number of spermatozoa inseminated on cost -effectiveness of the procedures was also determined. Result(s): Intra uterine inseminations, CC-IUI, and hMG-IUI have a similar cost per del ivery of between $7,800 and $10,300. All of these were more cost-effec tive than ART, which had a cost per delivery of $37,000. Assisted repr oductive techniques in women with blocked fallopian tubes was more cos t-effective than tubal surgery performed by laparotomy, which had a co st per delivery of $76,000. Increasing age in women and lower numbers of spermatozoa inseminated were factors leading to higher costs per de livery for IUI, CC-IUI, hMG-IUI, and ART. Use of donor oocytes reduced the cost per delivery of older women to the range seen in younger wom en with ART. Conclusion(s): Our analysis supports, in general, the use of IUI, CC-IUI, and hMG-IUI before ART in women with open fallopian t ubes. For women with blocked fallopian tubes, IVF-ET appears to be the best treatment from a cost-effectiveness standpoint. (C) 1997 by Amer ican Society for Reproductive Medicine.