Cost-effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial

BACKGROUND: In patients with ultrasound-visible hydrosalpinges, salpingectomy prior to IVF increases the chance of a live birth. This study compared the cost-effectiveness of this strategy (intervention) with that of optional salpingectomy after a failed cycle (control). METHODS: Data from a Scandinavian randomized controlled trial were used to calculate the individual number of treatments and their outcomes. Only patients with ultrasound-visible hydrosalpinges were considered in the main analysis, and a maximum of three fresh cycles were included. The costs for surgical procedures, IVF treatment, medication, complications, management of pregnancy and delivery as well as of early pregnancy losses were calculated from standardized hospital charges. RESULTS: Among the 51 patients in the intervention group, the live birth rate was 60.8% compared with 40.9% in 44 controls. The average cost per patient was 13 943euro and 12 091euro, respectively. Thus, the average cost per live birth was 22 823euro in the intervention group and 29 517eoro in the control group. The incremental cost-effectiveness ratio for adopting the intervention strategy was estimated at 9306euro. CONCLUSIONS: The incremental cost to achieve the higher birth rate of the intervention strategy seems reasonable.