Lee Richard, Li Philip S, Goldstein Marc, Schattman Glenn, Schlegel Peter N
James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th St., New York, NY 10021, USA.
Fertil Steril. 2009 Jul;92(1):188-96. doi: 10.1016/j.fertnstert.2008.05.053. Epub 2008 Aug 15.
To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI).
Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers.
Academic medical center.
PATIENT(S): Simulation with a decision analytic model.
INTERVENTION(S): Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI.
MAIN OUTCOME MEASURE(S): Cost-effectiveness.
RESULT(S): Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates.
CONCLUSION(S): Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.
探讨精索静脉曲张相关性非梗阻性无精子症初始治疗的经济影响，特别是精索静脉结扎术与显微外科睾丸精子提取术（TESE）联合体外受精/卵胞浆内单精子注射（ICSI）的比较。
基于1）辅助生殖技术协会（SART）数据库和同行评审文献的结果数据，以及2）医疗保险基于资源的相对价值量表的成本数据和美国高容量体外受精中心的抽样数据的决策分析模型。
学术医疗中心。
使用决策分析模型进行模拟。
精索静脉结扎术后成功自然活产率与体外受精/ICSI后成功活产率的差异。
成本效益。
显微外科TESE比精索静脉结扎术更具成本效益。1999年，显微外科TESE初始治疗（65,515美元）比精索静脉结扎术（76,878美元）更具成本效益。2005年相对成本效益未变：分别为69,731美元和79,576美元。两种治疗的成本效益相对于通货膨胀预测均有所提高。敏感性分析表明，只有在精索静脉结扎术后自然活产率大幅提高或体外受精成功率下降的情况下，TESE与精索静脉结扎术的相对成本效益才会改变。
考虑间接成本时，显微外科TESE治疗精索静脉曲张相关性非梗阻性无精子症似乎比精索静脉结扎术更具成本效益。两种治疗的成本效益均随时间有所提高。这些结果可根据机构特定数据进行调整，以获得更个性化的结果。
