Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review

Youssef Mouhayar, Ophelia Yin, Sunni L. Mumford, James Segars

Research output: Contribution to journalReview article

Abstract

The cost of fertility treatment is expensive and interventions that reduce cost can lead to greater efficiency and fewer embryos transferred. Endometrial polyps contribute to infertility and are frequently removed prior to infertility treatment. It is unclear whether polypectomy reduces fertility treatment cost and if so, the magnitude of cost reduction afforded by the procedure. The aim of this study was to determine whether performing office or operative hysteroscopic polypectomy prior to infertility treatment would be cost-effective. PubMed, Embase, and Cochrane libraries were used to identify publications reporting pregnancy rates after hysteroscopic polypectomy. Studies were required to have a polypectomy treatment group and control group of patients with polyps that were not resected. The charges of infertility treatments and polypectomy were obtained through infertility organizations and a private healthcare cost reporting website. These charges were applied to a decision tree model over the range of pregnancy rates observed in the representative studies to calculate an average cost per clinical or ongoing pregnancy. A sensitivity analysis was conducted to assess cost savings of polypectomy over a range of pregnancy rates and polypectomy costs. Pre-treatment office or operative hysteroscopic polypectomy ultimately saved €6658 ($7480) and €728 ($818), respectively, of the average cost per clinical pregnancy in women treated with four cycles of intrauterine insemination. Polypectomy prior to intrauterine insemination was cost-effective for clinical pregnancy rates greater than 30.2% for office polypectomy and 52.6% for operative polypectomy and for polypectomy price <€4414 ($4959). Office polypectomy or operative polypectomy saved €15,854 ($17,813) and €6644 ($7465), respectively, from the average cost per ongoing pregnancy for in vitro fertilization/intracytoplasmic sperm injection treated women and was cost-effective for ongoing pregnancy rates greater than 26.4% (office polypectomy) and 31.7% (operative polypectomy) and polypectomy price <€6376 ($7164). These findings suggested that office or operative hysteroscopic polypectomy was cost-effective when performed prior to both intrauterine insemination and in vitro fertilization over a range of plausible pregnancy rates and procedural costs.

Original languageEnglish (US)
Pages (from-to)107-115
Number of pages9
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume213
DOIs
StatePublished - Jun 1 2017

Fingerprint

Health Care Costs
Infertility
Costs and Cost Analysis
Pregnancy Rate
Insemination
Fertilization in Vitro
Polyps
Pregnancy
Fertility
Therapeutics
Decision Trees
Intracytoplasmic Sperm Injections
Cost Savings
PubMed
Libraries
Publications
Embryonic Structures
Organizations
Control Groups

Keywords

  • Cost-effectiveness
  • Endometrial polyps
  • Hysteroscopic polypectomy
  • In vitro fertilization
  • Infertility
  • Intrauterine insemination

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Hysteroscopic polypectomy prior to infertility treatment : A cost analysis and systematic review. / Mouhayar, Youssef; Yin, Ophelia; Mumford, Sunni L.; Segars, James.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 213, 01.06.2017, p. 107-115.

Research output: Contribution to journalReview article

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