%0 Journal Article
%T Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor subfertility
%A Nora Pashayan
%A Georgios Lyratzopoulos
%A Raj Mathur
%J BMC Health Services Research
%D 2006
%I BioMed Central
%R 10.1186/1472-6963-6-80
%X Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units.Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI) + IVF", and "stimulated IUI (S-IUI) + IVF" were ¡ê12,600, ¡ê13,100 and ¡ê15,100 per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional ¡ê174,200 and ¡ê438,000, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively.For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality) followed by IVF.In any health care system, cost-effective commissioning of health care in order to maximise population health outcomes with the minimum possible resource use, is an important consideration. The UK National Institute for Clinical Excellence (NICE) [1] recommends offer of up to six cycles of Unstimulated Intrauterine Insemination (U-IUI) for couples with unexplained or mild male factor subfertility. Supplementary cost calculation guidance suggested overall savings to the NHS from a "switch" of activity from Stimulated IUI (S-IUI) to U-IUI, which was also recommended [2]. These calculations however were based on 'head-to-head' comparisons between S-IUI and U-IUI and completely ignored the cost implications of the fact that many couples who fail IUI will subsequently require in-vitro fer
%U http://www.biomedcentral.com/1472-6963/6/80