Cost-effectiveness of hysteroscopy screening for infertile women

This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. The aim of this study was to assess the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared to the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine abnormalities (polyps, myoma, adhesions, septa) were treated during the hysteroscopy procedure. Two models were constructed and evaluated in a decision analysis. Model I assumed that all patients who underwent screening hysteroscopy prior to IVF would benefit of an increase in pregnancy rate. Model II assumed that the pregnancy rate solely increased in patients with intrauterine abnormalities, which were subsequently corrected by hysteroscopic treatment. For the three strategies, the total costs and live birth rates after a total of three IVF cycles were assessed. Also, sensitivity analysis was performed. Results were visualized in an incremental cost-effectiveness plane and a cost-effectiveness acceptability curve. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For this strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥2.8%. In model II (only patients with abnormalities benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance was accompanied with considerable costs. This concludes that the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the specific effect of hysteroscopy are needed.