Cost-effectiveness of hysterosalpingography, laparoscopy, and Chlamydia antibody testing in subfertile couples

Objective: To evaluate the cost-effectiveness analysis of hysterosalpingogr aphy (HSG), laparoscopy, and Chlamydia antibody testing (CAT) in subfertile couples. Design: Cost-effectiveness analysis. Setting: Decision analytic framework. Patient(s): Data of >2,000 subfertile couples in the Canadian Infertility T reatment Evaluation Study. Results of CA-125 measurement and CAT were simul ated from baseline characteristics. Intervention(s): Expectant management was considered to be the reference st rategy (strategy 1). In strategy 2 and 3, IVF was offered either immediatel y or after 2.5 years. In strategy 4, the decision to offer or delay treatme nt was based on the couple's chance of spontaneous conception. Nine strateg ies incorporated combinations of CAT, CA-125 measurement, HSG, and laparosc opy. Main Outcome Measure(s): Expected Live birth rates, expected number of IVF cycles, and expected total costs. Result(s): The strategy starting with CAT was the most cost-effective in co uples whose 3-year chance of conception was >14%, whereas the strategy star ting with HSG was the most cost-effective in couples with worse fertility p rospects. Conclusion(s): The diagnostic work-up to detect tubal pathology in subferti le couples should start with CAT in couples with relatively good fertility prospects and immediate HSG in couples with relatively poor fertility prosp ects. (C) 2001 by American Society for Reproductive Medicine.