Cost-effectiveness of hysterosalpingography, laparoscopy, and Chlamydia antibody testing in subfertile couples

Objective: To evaluate the cost-effectiveness analysis of hysterosalpingography (HSG), laparoscopy, and Chlamydia antibody testing (CAT) in subfertile couples. Design: Cost-effectiveness analysis. Setting: Decision analytic framework.Patient(s): Data of >2,000 subfertile couples in the Canadian Infertility Treatment Evaluation Study. Results of CA-125 measurement and CAT were simulated from baseline characteristics.Intervention(s): Expectant management was considered to be the reference strategy (strategy 1). In strategy 2 and 3, IVF was offered either immediately or after 2.5 years. In strategy 4, the decision to offer or delay treatment was based on the couple's chance of spontaneous conception. Nine strategies incorporated combinations of CAT, CA-125 measurement, HSG, and laparoscopy. Main Outcome Measure(s): Expected live birth rates, expected number of IVF cycles, and expected total costs. Result(s): The strategy starting with CAT was the most cost-effective in couples whose 3-year chance of conception was >14%, whereas the strategy starting with HSG was the most cost-effective in couples with worse fertility prospects. Conclusion(s): The diagnostic work-up to detect tubal pathology in subfertile couples should start with CAT in couples with relatively good fertility prospects and immediate HSG in couples with relatively poor fertility prospects.