Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective?

S. Wordsworth, J. Buchanan, J. Mollison, K. Harrild, L. Robertson, C. Tay, A. Harrold, D. McQueen, H. Lyall, L . Johnston, J. Burrage, S. Grossett, H. Walton, J. Lynch, A. Johnstone, S. Kini, A. Raja, A. Templeton, S. Bhattacharya

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Abstract

BACKGROUND First-line treatments for unexplained infertility traditionally include clomifene citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area.

METHODS Five hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental cost–effectiveness ratios were calculated, expressed as cost per live birth, in order to compare the cost–effectiveness of CC and IUI with that of EM to treat unexplained infertility.

RESULTS Live birth rates in the three randomized groups were: EM = 32/193 (17%), CC = 26/194 (13%) and IUI = 43/193 (22%). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95% confidence interval £0–£206), £2611 (£1870–£4166) and £1487 (£1116–£2155), respectively. The incremental cost–effectiveness ratio for IUI versus EM was £5604 (−£12204 to £2227), with CC dominated by IUI.

CONCLUSIONS Despite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The study's main limitation is that it did not consider the psychological effects on couples.
Original languageEnglish
Pages (from-to)369-375
Number of pages7
JournalHuman Reproduction
Volume26
Issue number2
Early online date2 Dec 2010
DOIs
Publication statusPublished - Feb 2011

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Clomiphene
Insemination
Citric Acid
Infertility
Costs and Cost Analysis
Live Birth
Birth Rate
Therapeutics
National Health Programs
Health Care Costs
Birth Order
Health Resources
Health Personnel
Cost-Benefit Analysis
Randomized Controlled Trials
Outcome Assessment (Health Care)
Confidence Intervals
Psychology

Keywords

  • cost–effectiveness
  • expectant management
  • unexplained infertility
  • clomifene citrate
  • intrauterine insemination

Cite this

Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility : are they cost-effective? / Wordsworth, S.; Buchanan, J.; Mollison, J.; Harrild, K.; Robertson, L.; Tay, C.; Harrold, A.; McQueen, D.; Lyall, H.; Johnston, L .; Burrage, J.; Grossett, S.; Walton, H.; Lynch, J.; Johnstone, A.; Kini, S.; Raja, A.; Templeton, A.; Bhattacharya, S.

In: Human Reproduction, Vol. 26, No. 2, 02.2011, p. 369-375.

Research output: Contribution to journalArticle

Wordsworth, S, Buchanan, J, Mollison, J, Harrild, K, Robertson, L, Tay, C, Harrold, A, McQueen, D, Lyall, H, Johnston, L, Burrage, J, Grossett, S, Walton, H, Lynch, J, Johnstone, A, Kini, S, Raja, A, Templeton, A & Bhattacharya, S 2011, 'Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective?', Human Reproduction, vol. 26, no. 2, pp. 369-375. https://doi.org/10.1093/humrep/deq315
Wordsworth, S. ; Buchanan, J. ; Mollison, J. ; Harrild, K. ; Robertson, L. ; Tay, C. ; Harrold, A. ; McQueen, D. ; Lyall, H. ; Johnston, L . ; Burrage, J. ; Grossett, S. ; Walton, H. ; Lynch, J. ; Johnstone, A. ; Kini, S. ; Raja, A. ; Templeton, A. ; Bhattacharya, S. / Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility : are they cost-effective?. In: Human Reproduction. 2011 ; Vol. 26, No. 2. pp. 369-375.
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T1 - Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility

T2 - are they cost-effective?

AU - Wordsworth, S.

AU - Buchanan, J.

AU - Mollison, J.

AU - Harrild, K.

AU - Robertson, L.

AU - Tay, C.

AU - Harrold, A.

AU - McQueen, D.

AU - Lyall, H.

AU - Johnston, L .

AU - Burrage, J.

AU - Grossett, S.

AU - Walton, H.

AU - Lynch, J.

AU - Johnstone, A.

AU - Kini, S.

AU - Raja, A.

AU - Templeton, A.

AU - Bhattacharya, S.

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N2 - BACKGROUND First-line treatments for unexplained infertility traditionally include clomifene citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area.METHODS Five hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental cost–effectiveness ratios were calculated, expressed as cost per live birth, in order to compare the cost–effectiveness of CC and IUI with that of EM to treat unexplained infertility.RESULTS Live birth rates in the three randomized groups were: EM = 32/193 (17%), CC = 26/194 (13%) and IUI = 43/193 (22%). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95% confidence interval £0–£206), £2611 (£1870–£4166) and £1487 (£1116–£2155), respectively. The incremental cost–effectiveness ratio for IUI versus EM was £5604 (−£12204 to £2227), with CC dominated by IUI.CONCLUSIONS Despite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The study's main limitation is that it did not consider the psychological effects on couples.

AB - BACKGROUND First-line treatments for unexplained infertility traditionally include clomifene citrate (CC) or unstimulated intrauterine insemination (IUI). A recently published randomized controlled trial considered the effectiveness of CC and IUI in patients with unexplained infertility and found that neither treatment offered a superior live birth rate when compared with expectant management (EM). This paper reports the economic evaluation conducted alongside this trial in order to assess whether health care providers are gaining value for money in this clinical area.METHODS Five hundred and eighty women across five Scottish hospitals were randomized to either EM, CC or IUI for 6 months. The primary outcome measure was live births. Resource-use data were collected during the trial and costs were calculated from a UK National Health Service (NHS) perspective. Incremental cost–effectiveness ratios were calculated, expressed as cost per live birth, in order to compare the cost–effectiveness of CC and IUI with that of EM to treat unexplained infertility.RESULTS Live birth rates in the three randomized groups were: EM = 32/193 (17%), CC = 26/194 (13%) and IUI = 43/193 (22%). The mean (standard deviation) costs per treatment cycle were £0 for EM, £83 (£17) for CC and £98 (£31) for IUI. The mean treatment costs per patient for EM, CC and IUI were £12 (£117), £350 (£220) and £331 (£222), respectively. The cost per live birth for EM, CC and IUI was £72 (95% confidence interval £0–£206), £2611 (£1870–£4166) and £1487 (£1116–£2155), respectively. The incremental cost–effectiveness ratio for IUI versus EM was £5604 (−£12204 to £2227), with CC dominated by IUI.CONCLUSIONS Despite being more expensive, existing treatments such as empirical CC and unstimulated IUI do not offer superior live birth rates compared with EM of unexplained infertility. They are unlikely to be a cost-effective use of limited NHS resources. The study's main limitation is that it did not consider the psychological effects on couples.

KW - cost–effectiveness

KW - expectant management

KW - unexplained infertility

KW - clomifene citrate

KW - intrauterine insemination

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DO - 10.1093/humrep/deq315

M3 - Article

VL - 26

SP - 369

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JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

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