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Oil-based or water-based contrast for hysterosalpingography in infertile women: a cost-effectiveness analysis of a
Joukje van Rijswijk1, Clarabelle T Pham2, Kim Dreyer1
1Department of Reproductive Medicine, Amsterdam University medical center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Objective:
To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG).
Design:
Economic evaluation alongside a multicenter randomized trial.
Setting:
Hospitals.
Patient(S):
Infertile women with an ovulatory cycle, 18-39 years of age, low risk of tubal pathology.
Intervention(S):
Use of oil-based versus water-based contrast during HSG.
Main Outcome Measure(S):
Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs).
Result(S):
A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth.
Conclusion(S):
Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology.
Clinical Trial Registration Number:
Dutch Trial Register, NTR 6577 (www.trialregister.nl).
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