Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.
Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2024 Apr;68(3):282-288. doi: 10.1111/1754-9485.13629. Epub 2024 Mar 4.
Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy.
Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation.
Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207).
Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.
精索静脉曲张在不孕男性中很常见。研究表明，精索静脉曲张修复（手术或栓塞）可以提高随后怀孕的几率。在澳大利亚，还没有研究评估精索静脉曲张栓塞的成本，目前的治疗方法是基于国际数据。本研究旨在评估精索静脉曲张栓塞的成本，并估计每例妊娠的治疗成本。
对 2018 年 1 月至 2023 年期间接受栓塞治疗的患者进行回顾性成本-效果研究。采用自下而上的方法计算手术成本，而采用自上而下的方法计算所有其他患者服务的成本，包括直接成本和间接成本。为了计算每例妊娠的成本，根据现有发表的栓塞后妊娠率数据对成本进行了调整。
纳入了 18 例患者的成本数据，患者年龄中位数为 33.5 岁（范围 26-60 岁），精索静脉曲张等级中位数为 2.5 级（范围 1-3 级）。所有患者均接受单侧治疗，最常见的是通过右侧颈内静脉（16 例，89%）和使用 0.035″系统（17 例，94%）。包括手术、非手术、病房和围手术期成本在内的整个治疗成本中位数为 2208.10 澳元（1405 美元或 1314 欧元），范围为 1691-7051 澳元。每例妊娠的医疗系统预计成本为 2208.10 澳元（1405 美元或 1314 欧元）。
精索静脉曲张栓塞的总治疗成本和每例妊娠的成本均低于现有国际研究中的栓塞和手术修复成本。接受精索静脉曲张治疗的患者应该有机会选择介入放射科医生来实现这种低成本微创治疗的好处。
