Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost effectiveness of laparoscopy for unexplained infertility. DESIGN: We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates. SETTING: Academic in vitro fertilization practice. PATIENT(S): Computer-simulated patients assigned to one of four treatments. INTERVENTION(S): Fertility treatment or laparoscopy. MAIN OUTCOME MEASURE(S): Incremental cost-effectiveness ratios. RESULT(S): Using base-case assumptions, LSC/EM was preferred (ICER =$128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments-SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity. CONCLUSION(S): Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.\ (August 2009)