Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness?
Document Type
Journal Article
Publication Date
10-1-2007
Journal
Fertility and Sterility
Volume
88
Issue
4
DOI
10.1016/j.fertnstert.2006.11.199
Keywords
assisted reproductive technology; cost effectiveness; decision analysis; Markov process; vasectomy reversal
Abstract
Objective: To apply Markov models to assess the cost effectiveness of the relative impact of obstructive interval and female partner age on fertility using either assisted reproductive technology (ART) or vasectomy reversal, and elucidate the impact of these variables on fertility. Design: Markov models based on review of published literature and available ART outcome data. Setting: University-based clinical practice. Patient(s): Simulation runs of 50,000 patients for each analysis. Intervention(s): Varying vasectomy obstructive interval and maternal age. Main Outcome Measure(s): Cost effectiveness, willingness to pay (WTP), and net health benefit. Result(s): Base case analysis showed ART yields a higher pregnancy rate and higher cost than vasectomy reversal. Sensitivity analysis showed female age has a greater effect on cost effectiveness than obstructive interval. At a WTP < $65,000, vasectomy reversal is more cost effective than ART. With increasing WTP, ART is more cost effective over wider windows of female age. Conclusion(s): Markov modeling of fertility after vasectomy suggests female age has more impact than vasectomy obstructive interval on cost effectiveness. © 2007 American Society for Reproductive Medicine.
APA Citation
Hsieh, M., Meng, M., & Turek, P. (2007). Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness?. Fertility and Sterility, 88 (4). http://dx.doi.org/10.1016/j.fertnstert.2006.11.199