Van Voorhis B J, Sparks A E, Allen B D, Stovall D W, Syrop C H, Chapler F K
Division of Reproductive Endocrinology, University of Iowa College of Medicine, Iowa City, USA.
Fertil Steril. 1997 May;67(5):830-6. doi: 10.1016/s0015-0282(97)81393-3.
To determine the cost-effectiveness of infertility treatments.
Retrospective cohort study.
Academic medical center infertility practice.
PATIENT(S): All patients treated for infertility in a 1-year time span.
INTERVENTION(S): Intrauterine inseminations, clomiphene citrate and IUI (CC-IUI), hMG and IUI (hMG-IUI), assisted reproductive techniques (ART), and neosalpingostomy by laparotomy.
MAIN OUTCOME MEASURE(S): All medical charges and pregnancy outcomes associated with the treatments were obtained. Cost-effectiveness ratios defined as cost per delivery were determined for each procedure. The effects of a woman's age and the number of spermatozoa inseminated on cost-effectiveness of the procedures was also determined.
RESULT(S): Intrauterine inseminations, CC-IUI, and hMG-IUI have a similar cost per delivery of between $7,800 and $10,300. All of these were more cost-effective than ART, which had a cost per delivery of $37,000. Assisted reproductive techniques in women with blocked fallopian tubes was more cost-effective than tubal surgery performed by laparotomy, which had a cost per delivery of $76,000. Increasing age in women and lower numbers of spermatozoa inseminated were factors leading to higher costs per delivery for IUI, CC-IUI, hMG-IUI, and ART. Use of donor oocytes reduced the cost per delivery of older women to the range seen in younger women with ART.
CONCLUSION(S): Our analysis supports, in general, the use of IUI, CC-IUI, and hMG-IUI before ART in women with open fallopian tubes. For women with blocked fallopian tubes, IVF-ET appears to be the best treatment from a cost-effectiveness standpoint.
确定不孕症治疗的成本效益。
回顾性队列研究。
学术医疗中心不孕症诊疗科室。
在1年时间跨度内接受不孕症治疗的所有患者。
宫腔内人工授精、枸橼酸氯米芬与宫腔内人工授精（CC-IUI）、人绝经期促性腺激素与宫腔内人工授精（hMG-IUI）、辅助生殖技术（ART）以及开腹输卵管造口术。
获取与治疗相关的所有医疗费用及妊娠结局。确定每种治疗方法以每次分娩成本定义的成本效益比。还确定了女性年龄和授精精子数量对治疗方法成本效益的影响。
宫腔内人工授精、CC-IUI和hMG-IUI每次分娩成本相似，在7800美元至10300美元之间。所有这些方法都比ART更具成本效益，ART每次分娩成本为37000美元。输卵管阻塞女性的辅助生殖技术比开腹输卵管手术更具成本效益，开腹输卵管手术每次分娩成本为76000美元。女性年龄增加和授精精子数量减少是导致IUI、CC-IUI、hMG-IUI和ART每次分娩成本更高的因素。使用供体卵母细胞可将老年女性每次分娩成本降低至年轻女性接受ART时的成本范围。
总体而言，我们的分析支持输卵管通畅的女性在接受ART之前先使用IUI、CC-IUI和hMG-IUI。对于输卵管阻塞的女性，从成本效益角度来看，体外受精-胚胎移植似乎是最佳治疗方法。
