Cost-effectiveness modelling of three different hysterosalpingography diagnostic strategies in addition to standard fertility management for couples with unexplained infertility in the United Kingdom

Previous studies have demonstrated hysterosalpingography (HSG) in general, and
specifically with an oil-soluble contrast medium, directly increases pregnancy rates. Decision modelling was performed to compare fertility management using three HSG diagnostic strategies, Lipiodol® Ultra Fluid HSG (LUF-HSG), no HSG and watersoluble contrast medium (WSCM) HSG for women aged ≤39 years with unexplained infertility. Four reimbursement scenarios were modelled to reflect the various funding arrangements across the regions of the UK. Compared with WSCM-HSG, the live birth rates after 24 months increased by 3.4% with LUF-HSG and decreased by 2.7% with no HSG. From a patient perspective, fertility management with LUF-HSG is the most cost-effective strategy with cost-savings ranging from £299 - £857 per patient depending on the funding arrangement for IVF. From an NHS perspective, fertility management with LUF-HSG is cost-effective when 2 or more IVF cycles are NHSfunded. If none of the IVF cycles are NHS-funded, fertility management with LUFHSG can be considered cost-effective if society is willing to pay £8,353 for an additional live birth. The findings from this analysis suggest that fertility management with WSCM-HSG is cost-effective compared to no HSG and LUF-HSG is the most cost-effective with increased live birth rates after 24 months.