Use of algorithmic pathways to develop quality, cost-effective clinical care

Area of Science:

• Reproductive Medicine
• Health Economics
• Gynecologic Surgery

Background:

• Hydrosalpinges and pelvic adhesions are significant causes of infertility.
• Algorithmic diagnostic and treatment pathways are used to manage these conditions.
• In vitro fertilization (IVF) is a common but costly treatment option.

Purpose of the Study:

• To analyze the cost-effectiveness of various diagnostic and treatment pathways for hydrosalpinges and pelvic adhesions.
• To compare the cost per achieved pregnancy for different management strategies.

Main Methods:

• Retrospective analysis of six defined algorithmic pathways involving Chlamydia IgG titers, hysterosalpingogram (HSG), diagnostic laparoscopy, therapeutic laparoscopy, and IVF.
• Mathematical modeling was used to calculate the theoretical cost per pregnancy for each pathway.
• Data were sourced from a tertiary care practice at a university-associated hospital.

Main Results:

• The most cost-effective pathway for adhesions involved diagnosis and treatment at laparoscopy without prior screening, costing $18,883 per pregnancy.
• For hydrosalpinges, starting with an HSG was the least costly approach at $26,614 per pregnancy.
• All pathways for adhesions and screening pathways using HSG for hydrosalpinges were more cost-effective than IVF alone.

Conclusions:

• Laparoscopy for pelvic adhesions and HSG for hydrosalpinges appear to be the most cost-effective approaches to achieving pregnancy.
• The study acknowledges limitations due to assumptions and a tertiary care population.
• Primary care screening with Chlamydia trachomatis IgG antibody testing may offer a more cost-effective strategy.