Cost-effectiveness of treatments for male infertility: A review

Background: An etiologic factor is found in a majority of male infertility cases. Treatment may be either targeted specifically at the diagnosis, or is nonspecific. Assisted reproduction (specifically intracytoplasmic sperm injection (ICSI)) is a nonspecific form of treatment used for couples with different male-factor diagnosis. The authors chose to evaluate the cost-effectiveness of specific treatments for male infertility relative to that of nonspecific alternative treatments. Methods: A review of cost-effectiveness literature on Medline (1966-present) was performed. Cost-effectiveness was defined as cost per delivery, and was directly determined for specific and idiopathic causes of male infertility, or appraised critically from published studies. Overall procedural costs and actual delivery charges were included in every estimate, which took into account the costs of multiple gestation pregnancies and their increased neonatal support expenditures. Results: Diagnosis-specific treatments are more cost-effective than initial treatment with assisted reproduction for varicocele-associated obstructive and endocrine causes of male infertility. Cost per delivery for varicocelectomy is $26,300 US (treatment-specific delivery rate [DR] = 15%), for microsurgical reconstruction is $25,745 US (DR = 47%), and for endocrine therapy for hypogonadotropic hypogonadism is $15,226 US (DR = 59%). Similar cost analyses show that ICSI, with or without sperm retrieval, costs between $70,000 and $90,000 per delivery (overall DR = 33%). Although idiopathic male infertility has no proven therapy, intrauterine insemination (IUI) and ICSI provide real, albeit costly, chances at conception for these patients. Conclusions: Specific treatment of reproductive tract obstruction was more effective and more cost-effective than sperm retrieval and ICSI. Varicocelectomy was more cost-effective than ICSI for varicocele-associated infertility. The high cost per delivery of ICSI indicates that ICSI should not be used as an initial treatment if other therapies are available.