Hsieh Michael H, Meng Maxwell V, Turek Paul J
University of California San Francisco, Department of Urology, San Francisco, California, USA.
Fertil Steril. 2007 Oct;88(4):840-6. doi: 10.1016/j.fertnstert.2006.11.199. Epub 2007 Jun 4.
To apply Markov models to assess the cost effectiveness of the relative impact of obstructive interval and female partner age on fertility using either assisted reproductive technology (ART) or vasectomy reversal, and elucidate the impact of these variables on fertility.
Markov models based on review of published literature and available ART outcome data.
University-based clinical practice.
PATIENT(S): Simulation runs of 50,000 patients for each analysis.
INTERVENTION(S): Varying vasectomy obstructive interval and maternal age.
MAIN OUTCOME MEASURE(S): Cost effectiveness, willingness to pay (WTP), and net health benefit.
RESULT(S): Base case analysis showed ART yields a higher pregnancy rate and higher cost than vasectomy reversal. Sensitivity analysis showed female age has a greater effect on cost effectiveness than obstructive interval. At a WTP < $65,000, vasectomy reversal is more cost effective than ART. With increasing WTP, ART is more cost effective over wider windows of female age.
CONCLUSION(S): Markov modeling of fertility after vasectomy suggests female age has more impact than vasectomy obstructive interval on cost effectiveness.
应用马尔可夫模型评估梗阻时间和女性伴侣年龄对使用辅助生殖技术（ART）或输精管复通术的生育能力的相对影响的成本效益，并阐明这些变量对生育能力的影响。
基于对已发表文献和可用ART结果数据的综述的马尔可夫模型。
基于大学的临床实践。
每次分析对50,000名患者进行模拟运行。
改变输精管梗阻时间和产妇年龄。
成本效益、支付意愿（WTP）和净健康效益。
基础病例分析显示，ART的妊娠率高于输精管复通术，成本也更高。敏感性分析表明，女性年龄对成本效益的影响大于梗阻时间。当WTP<$65,000时，输精管复通术比ART更具成本效益。随着WTP的增加，在更宽的女性年龄范围内，ART更具成本效益。
输精管切除术后生育能力的马尔可夫模型表明，女性年龄对成本效益的影响大于输精管梗阻时间。
