Department of Obstetrics and Gynaecology and National Women's Health, Faculty of Medical and Health Sciences, University of Auckland, Level 12, ACH Support Building, Auckland City Hospital, Park Road, Grafton Private Bag 92019, Auckland 1142, New Zealand.
Hum Reprod. 2011 Nov;26(11):3037-44. doi: 10.1093/humrep/der279. Epub 2011 Sep 6.
In New Zealand, public funding for assisted reproductive technology (ART) is restricted to subfertile women who are unlikely to conceive spontaneously, based on clinical and social criteria known as the clinical priority access criteria (CPAC) score. The objective of this study was to compare this CPAC score with a prediction model for predicting spontaneous conception, developed in the Netherlands (the Hunault model).
We performed a cohort study and included couples with unexplained subfertility and assessed the measure of agreement and the performance of the CPAC score and the Hunault prediction score.
Of 663 couples referred, 249 (38%) couples had unexplained subfertility. Of 246 women with full follow-up data, there were 143 women (58%) who had a live birth during the follow-up period, 65 (26%) after fertility treatment and 78 (32%) after natural conception. There were 100 couples (41%) who had a Hunault prediction score of <30%, which is the Dutch treatment threshold, and 36 couples (15%) who had a CPAC score of >65, which is the New Zealand threshold for publically funded treatment. There were 69 couples (28%) who meet the threshold for treatment in the Netherlands but did not meet the New Zealand threshold for public funding. The kappa coefficient as a measure of agreement of the two scores and their treatment thresholds was 0.30, suggesting a fair agreement. The area under the curve for the CPAC and Hunault scores were both 0.63, but the Hunault model performed better in calibration.
The CPAC score correlates fairly with the Hunault prediction score, although using the Hunault prediction model 26% more couples would be recommended for ART. The discriminative capacities of both scores were comparable, but the Hunault prediction score performed better in calibration. Funding models in New Zealand should consider treating those women with unexplained subfertility who are least likely to conceive spontaneously.
在新西兰，辅助生殖技术（ART）的公共资金仅提供给那些根据临床和社会标准（即临床优先准入标准[CPAC]评分）被认为不太可能自然受孕的不孕女性。本研究的目的是比较 CPAC 评分与荷兰开发的预测自然受孕的预测模型（Hunault 模型）。
我们进行了一项队列研究，纳入了不明原因不孕的夫妇，并评估了 CPAC 评分和 Hunault 预测评分的一致性和性能。
在 663 对被转诊的夫妇中，有 249 对（38%）夫妇患有不明原因的不孕。在 246 名有完整随访数据的女性中，有 143 名女性（58%）在随访期间分娩，65 名（26%）在接受生育治疗后分娩，78 名（32%）在自然受孕后分娩。有 100 对（41%）夫妇的 Hunault 预测评分<30%，这是荷兰的治疗阈值，有 36 对（15%）夫妇的 CPAC 评分>65，这是新西兰公共资助治疗的阈值。有 69 对（28%）夫妇符合荷兰的治疗阈值，但不符合新西兰的公共资金资助阈值。这两个评分及其治疗阈值的一致性的 Kappa 系数为 0.30，表明存在适度的一致性。CPAC 和 Hunault 评分的曲线下面积均为 0.63，但 Hunault 模型的校准效果更好。
CPAC 评分与 Hunault 预测评分有适度的相关性，尽管使用 Hunault 预测模型，会有 26%更多的夫妇被建议接受 ART。这两个评分的判别能力相当，但 Hunault 预测评分的校准效果更好。新西兰的资金模式应考虑对那些自然受孕可能性最低的不明原因不孕女性进行治疗。
