Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam Amsterdam, the Netherlands.
Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
Reprod Biomed Online. 2021 Jan;42(1):150-157. doi: 10.1016/j.rbmo.2020.09.015. Epub 2020 Sep 17.
What are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)?
This economic evaluation of a long-term follow-up of a multicentre randomized controlled trial involved 1119 infertile women randomized to HSG with oil- (n = 557) or water-based contrast (n = 562) in the Netherlands.
In the oil-based contrast group, 39.8% of women needed no other treatment, 34.6% underwent intrauterine insemination (IUI) and 25.6% had IVF/intracytoplasmic sperm injection (ICSI) in the 5 years following HSG. In the water-based contrast group, 35.0% of women had no other treatment, 34.2% had IUI and 30.8% had IVF/ICSI in the 5 years following HSG (P = 0.113). After 5 years of follow-up, HSG using oil-based contrast resulted in equivalent costs (mean cost difference -€144; 95% confidence interval [CI] -€579 to +€290; P = 0.515) for a 5% increase in the cumulative ongoing pregnancy rate compared with HSG using water-based contrast (80% compared with 75%, Relative Risk (RR) 1.07; 95% CI 1.00-1.14). Similarly, HSG with oil-based contrast resulted in equivalent costs (mean cost difference -€50; 95% CI -€576 to +€475; P = 0.850) for a 7.5% increase in the cumulative live birth rate compared with HSG with water-based contrast (74.8% compared with 67.3%, RR 1.11; 95% CI 1.03-1.20), making it the dominant strategy. Scenario analyses suggest that the oil-based contrast medium is the dominant strategy up to a price difference of €300.
Over a 5-year follow-up, HSG with an oil-based contrast was associated with a 5% increase in ongoing pregnancy rate, a 7.5% increase in live birth rate and similar costs to HSG with water-based contrast.
在接受子宫输卵管造影术（HSG）的不孕女性中，油基与水基对比剂的长期成本和效果如何？
这是一项对多中心随机对照试验进行长期随访的经济学评估，涉及 1119 名随机分配至 HSG 的不孕女性，分别接受油基对比剂（n=557）或水基对比剂（n=562）。
在油基对比剂组中，HSG 后 5 年内，39.8%的女性无需进一步治疗，34.6%接受宫腔内人工授精（IUI），25.6%接受体外受精/胞浆内单精子注射（ICSI）。在水基对比剂组中，35.0%的女性无需进一步治疗，34.2%接受 IUI，30.8%接受 IVF/ICSI。HSG 后 5 年，油基对比剂组的累积持续妊娠率增加 5%，与水基对比剂组相比，成本相当（平均成本差异-€144；95%置信区间[CI] -€579 至 +€290；P=0.515）（80%比 75%，相对风险[RR] 1.07；95%CI 1.00-1.14）。同样，油基对比剂组的累积活产率增加 7.5%，与水基对比剂组相比，成本相当（平均成本差异-€50；95%CI -€576 至 +€475；P=0.850）（74.8%比 67.3%，RR 1.11；95%CI 1.03-1.20），使其成为主导策略。情景分析表明，在价格差异达到€300 时，油基造影剂是主导策略。
在 5 年的随访中，油基对比剂 HSG 与持续妊娠率增加 5%、活产率增加 7.5%以及与水基对比剂 HSG 成本相当相关。
