Pavlovich C P, Schlegel P N
James Buchanan Brady Foundation. Department of Urology, New York Hospital-Cornell Medical Center, New York 10021, USA.
Fertil Steril. 1997 Jan;67(1):133-41. doi: 10.1016/s0015-0282(97)81870-5.
To evaluate cost per delivery using two different initial approaches to the treatment of postvasectomy infertility.
Model of expected costs and results in the United States in 1994.
Men with postvasectomy infertility, evaluated and treated at centers with experience in vasectomy reversal or sperm retrieval and ICSI.
PATIENT(S): Men with postvasectomy infertility, with a female partner < or = 39 years of age.
INTERVENTION(S): Initial microsurgical vasectomy reversal was compared with retrieved epididymal or testicular sperm. Actual treatment charges, complication rates, and pregnancy and delivery rates obtained in the United States were used for cost per delivery analysis.
MAIN OUTCOME MEASURE(S): Cost per delivery, delivery rates.
RESULT(S): Cost per delivery with an initial approach of vasectomy reversal was only $25,475. (95% confidence interval $19,609 to $31,339), with a delivery rate of 47%. However, the cost per delivery after sperm retrieval and ICSI was $72,521. (95% confidence interval $63,357 to $81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. The delivery rate after one cycle of sperm retrieval and ICSI was 33%.
CONCLUSION(S): The most cost-effective approach to treatment of postvasectomy infertility is microsurgical vasectomy reversal. This treatment also has the highest chance of resulting in delivery of a child for a single intervention.
采用两种不同的初始方法治疗输精管切除术后不育症，评估每次分娩的成本。
1994年美国预期成本和结果模型。
在输精管复通或精子采集及卵胞浆内单精子注射（ICSI）方面有经验的中心对输精管切除术后不育的男性进行评估和治疗。
输精管切除术后不育的男性，其女性伴侣年龄≤39岁。
将初始显微外科输精管复通术与附睾或睾丸精子采集进行比较。使用在美国获得的实际治疗费用、并发症发生率以及妊娠和分娩率进行每次分娩成本分析。
每次分娩成本、分娩率。
初始采用输精管复通术方法时，每次分娩成本仅为25475美元（95%置信区间为19609美元至31339美元），分娩率为47%。然而，精子采集及ICSI后的每次分娩成本为72521美元（95%置信区间为63357美元至81685美元），经皮或睾丸精子采集平均为73146美元，手术附睾精子采集平均为71896美元。精子采集及ICSI一个周期后的分娩率为33%。
治疗输精管切除术后不育症最具成本效益的方法是显微外科输精管复通术。这种治疗方法在单次干预中也有最高的生育机会。
