Vasectomy Reversal Remains More Cost-Effective Than IVF
Urology – October 30, 2008 – Vol. 24 – No. 11
Vasectomy reversal is more cost-effective than sperm aspiration and in vitro fertilization for obstructive azoospermia.
Article Reviewed: A Decision Analysis of Treatments for Obstructive Azoospermia. Lee R, Li PS, et al: Hum Reprod; 2008;23 (September): 2043-2049.
Background: Management of post-vasectomy obstructive azoospermia is either vasectomy reversal or sperm aspiration with in vitro fertilization (IVF) intracytoplasmic sperm injection (ICSI). The cost of IVF and issue of multiples has broad implications for public health policy and allocation of resources. The change in cost of male factor infertility over time with the evolution of new techniques like ICSI has not been studied.
Objective: To investigate and compare the economic impact of IVF versus vasectomy reversal for obstructive azoospermia over time using population data and analytic models.
Design: Decision analytic model.
Methods: The decision analytic model was used to simulate treatment. Outcome probabilities for treatment options were created from the literature and Society of Assisted Reproductive Technology (SART) databases. National pricing trends for procedures were obtained from 5 high-volume IVF centers as well as the Medicare Resource Based Relative Value Scale. Procedural costs were examined for sensitivity analysis at 5 high-volume andrology labs. Indirect costs for multiple gestations (from peer-reviewed literature), complications, and lost productivity (based on national median income rates) were considered. Pregnancy rates were obtained from SART data from 1999 and 2005 and vasectomy reversal rates from peer-reviewed literature.
Results: Vasectomy reversal was more cost-effective than sperm aspiration and IVF under all probability conditions ($20,000 vs $46,000 to $49,000 in 1999 and $25,000 vs $60,000 to $62,000 in 2005). Cost-effectiveness did not change over time, nor did indirect costs. The cost-effectiveness of all treatments improved over projections by inflation.
Conclusions:
Vasectomy reversal is more cost-effective than sperm aspiration and IVF-ICSI with all variables considered. Results need to be tailored to institution-specific data to allow for more individualized cost analysis.
Reviewer’s Comments: Development of IVF-ICSI has led to a change in options for men with obstructive azoospermia secondary to vasectomy. This paper looks at numerous important variables from direct costs to indirect costs such as lost productivity and cost of multiples from IVF, to success rates from different techniques. The paper does try to look at cost based on the highest-volume practices to try to generalize cost analysis, but such papers are always limited. Actual costs for each individual institution need to be calculated based on regional outcomes and costs. (Reviewer–Ajay K. Nangia, MBBS).