Evaluation of the relative cost-effectiveness of treatments for infertility in the UK

This paper aims to complement existing clinical guidelines by providing evi dence of the relative cost-effectiveness of treatments for infertility in t he UK. A series of decision-analytical models have been developed to reflec t current diagnostic and treatment pathways for the five main causes of inf ertility. Data to populate the models are derived from a systematic review and routine National Health Service activity data, and are augmented with e xpert opinion. Costs are derived from an analysis of extra-contractual refe rral tariffs and private sector data. Sensitivity analysis has been carried out to take account of the uncertainty of model parameters and to allow re sults to be interpreted in the light of local circumstances. Results of the modelling exercise suggest in-vitro fertilization is the most cost-effecti ve treatment option for severe tubal factors and endometriosis, with surger y the most cost-effective in the case of mild or moderate disease. Ovulator y factors should be treated medically with the addition of laparoscopic ova rian diathermy in the presence of polycystic ovarian syndrome. For other ca uses, stimulated intrauterine insemination (unexplained and moderate male f actor) and stimulated donor intrauterine insemination (severe male) are cos t-effective.