Schlegel P N
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, NY 10021, USA.
Urology. 1997 Jan;49(1):83-90. doi: 10.1016/S0090-4295(96)00379-2.
To evaluate the cost-effectiveness of assisted reproduction using in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) as a primary treatment for varicocele-associated infertility.
Analysis of cost per delivery using published and contemporary results for treatment with ICSI in the United States for male factor infertility was compared with cost per delivery after surgical varicocelectomy. Only results from controlled trials of varicocelectomy were used for evaluation of pregnancy and delivery rates. Cost estimates were based on prevailing nationwide charges for services in 1994.
The cost per delivery with ICSI was found to be $89,091 (95% confidence interval $78,720 to $99,462), whereas the cost per delivery after varicocelectomy was only $26,268 (95% confidence interval $19,138 to $44,656). Assuming the highest possible published success rate for ICSI resulted in a cost estimate as low as $62,263. The average published U.S. delivery rate after one attempt of ICSI was only 28%. whereas a 30% delivery rate was obtained after varicocelectomy.
Specific treatment of varicocele-associated male factor infertility with surgical varicocelectomy is more cost-effective than primary treatment with assisted reproduction. Continued evaluation and treatment of the man with infertility is warranted. Despite the apparent success of ICSI for the most severe cases of male factor infertility, application of assisted reproduction for all cases of male factor infertility also does not necessarily provide as high a delivery rate as specific treatment of the cause of male factor infertility.
评估采用体外受精（IVF）联合卵胞浆内单精子注射（ICSI）作为精索静脉曲张相关性不育的主要治疗方法时的成本效益。
利用美国已发表的关于ICSI治疗男性因素不育的当代结果，分析每例分娩的成本，并与精索静脉曲张手术后每例分娩的成本进行比较。仅使用精索静脉曲张手术对照试验的结果来评估妊娠率和分娩率。成本估计基于1994年全国范围内现行的服务收费。
发现ICSI每例分娩的成本为89,091美元（95%置信区间为78,720美元至99,462美元），而精索静脉曲张手术后每例分娩的成本仅为26,268美元（95%置信区间为19,138美元至44,656美元）。假设ICSI公布的最高成功率，得出的成本估计低至62,263美元。在美国，一次ICSI尝试后的平均公布分娩率仅为28%，而精索静脉曲张手术后的分娩率为30%。
采用精索静脉曲张手术对精索静脉曲张相关性男性因素不育进行特异性治疗比采用辅助生殖作为主要治疗方法更具成本效益。对不育男性进行持续评估和治疗是有必要的。尽管ICSI在最严重的男性因素不育病例中取得了明显成功，但对所有男性因素不育病例应用辅助生殖也不一定能提供与特异性治疗男性因素不育病因一样高的分娩率。
