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  • Title: Fertility options after vasectomy: a cost-effectiveness analysis.
    Author: Pavlovich CP, Schlegel PN.
    Journal: Fertil Steril; 1997 Jan; 67(1):133-41. PubMed ID: 8986698.
    Abstract:
    OBJECTIVE: To evaluate cost per delivery using two different initial approaches 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 with experience in vasectomy reversal or sperm retrieval and ICSI. PATIENT(S): Men with postvasectomy infertility, with a female partner < or = 39 years of age. INTERVENTION(S): Initial microsurgical vasectomy reversal was compared with retrieved epididymal or testicular sperm. Actual treatment charges, complication rates, and pregnancy and delivery rates obtained in the United States were used for cost per delivery analysis. MAIN OUTCOME MEASURE(S): Cost per delivery, delivery 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 delivery after sperm retrieval and ICSI was $72,521. (95% confidence interval $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 ICSI was 33%. CONCLUSION(S): The most cost-effective approach to treatment of postvasectomy infertility is microsurgical vasectomy reversal. This treatment also has the highest chance of resulting in delivery of a child for a single intervention. Calculations of cost per delivery for vasectomy reversal versus sperm retrieval-intracytoplasmic sperm injection (ICSI) under a wide variety of initial assumptions clearly indicate that vasectomy reversal is associated with lower costs per delivery and higher delivery rates. The data for the models on average postvasectomy infertility costs were derived from 6 specialized medical centers in the US in 1994; only men with female partners 39 years or younger were included. The overall vasectomy reversal pregnancy rate was 52%, with an estimated live delivery rate of 47%; for sperm retrieval and ICSI procedures, the mean weighted delivery rate per attempt was 33%. The average cost per delivery for vasectomy reversal (including pretreatment evaluation, surgeon's fee, anesthesia, ambulatory charges, complication costs, lost work costs, and delivery costs weighted for the number of procedures performed at each center) was US $25,475 (95% confidence interval, $19,609-31,339). In contrast, the cost per delivery after sperm retrieval and ICSI was US $72,521 (95% confidence interval, $63,357-81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. Overall inpatient charges for delivery of a singleton gestation were $9845 ($37,947 for twin gestations and $109,765 for triplet gestations). Unless microsurgical epididymal sperm aspiration results improve dramatically or ICSI procedural costs and multiple gestation rates decrease, vasectomy reversal will remain the indicated treatment for men interested in fertility restoration after vasectomy.
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