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Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

R I Tjon-Kon-Fat1, A J Bensdorp1, P M M Bossuyt2

  • 1Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

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Summary

Intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) is the most cost-effective first-line treatment for unexplained infertility compared to in vitro fertilization (IVF) strategies. Both IVF-SET and IVF-MNC are more expensive without significant effectiveness gains over IUI-COH.

Keywords:
cost-effectivenessin vitro fertilizationintrauterine inseminationmodified natural cyclesingle embryo transfer

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Area of Science:

  • Reproductive Medicine
  • Health Economics
  • Infertility Treatment

Background:

  • Intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) and in vitro fertilization (IVF) are first-line treatments for unexplained or mild male subfertility.
  • IUI-COH is typically preferred due to its less invasive nature.
  • IVF with single embryo transfer (SET) and modified natural cycle (MNC) have been proposed as alternatives due to potentially higher pregnancy rates and lower multiple birth rates.

Purpose of the Study:

  • To compare the cost-effectiveness of IVF-SET and IVF-MNC against IUI-COH as a first-line treatment for unexplained infertility with a poor prognosis for natural conception.

Main Methods:

  • A cost-effectiveness analysis was conducted alongside a randomized noninferiority trial involving 602 couples.
  • Participants were allocated to three cycles of IVF-SET, six cycles of IVF-MNC, or six cycles of IUI-COH.
  • Data on resource use and costs were collected, and incremental cost-effectiveness ratios (ICER) were calculated.

Main Results:

  • The mean costs per couple were €7187 for IVF-SET, €8206 for IVF-MNC, and €5070 for IUI-COH.
  • IVF-SET and IVF-MNC were significantly more expensive than IUI-COH.
  • The ICER for IVF-SET was €43,375 per additional healthy child; IUI-COH was the dominant strategy compared to IVF-MNC.

Conclusions:

  • IUI-COH remains the most cost-effective first-line treatment for unexplained infertility.
  • IVF strategies are significantly more expensive without a corresponding significant increase in effectiveness.
  • The study supports IUI-COH as the preferred initial treatment option.