STUDY QUESTION<\/p>\n
Is optimal adherence to guideline recommendations in intrauterine insemination (IUI) care cost-effective from a societal perspective when compared with suboptimal adherence to guideline recommendations?<\/p>\n
SUMMARY ANSWER<\/p>\n
Optimal guideline adherence in IUI care has substantial economic benefits when compared with suboptimal guideline adherence.<\/p>\n
WHAT IS KNOWN ALREADY<\/p>\n
Fertility guidelines are tools to help health-care professionals, and patients make better decisions about clinically effective, safe and cost-effective care. Up to now, there has been limited published evidence about the association between guideline adherence and cost-effectiveness in fertility care.<\/p>\n
STUDY DESIGN, SIZE, DURATION<\/p>\n
In a retrospective cohort study involving medical record analysis and a patient survey (n<\/I> = 415), interviews with staff members (n<\/I> = 13) and a review of hospitals' financial department reports and literature, data were obtained about patient characteristics, process aspects and clinical outcomes of IUI care and resources consumed. In the cost-effectiveness analyses, restricted to four relevant guideline recommendations, the ongoing pregnancy rate per couple (effectiveness), the average medical and non-medical costs of IUI care, possible additional IVF treatment, pregnancy, delivery and period from birth up to 6 weeks after birth for both mother and offspring per couple (costs) and the incremental net monetary benefits were calculated to investigate if optimal guideline adherence is cost-effective from a societal perspective when compared with suboptimal guideline adherence.<\/p>\n
PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/p>\n
Seven hundred and sixty five of 1100 randomly selected infertile couples from the databases of the fertility laboratories of 10 Dutch hospitals, including 1 large university hospital providing tertiary care and 9 public hospitals providing secondary care, were willing to participate, but 350 couples were excluded because of ovulatory disorders or the use of donated spermatozoa (n<\/I> = 184), still ongoing IUI treatment (n<\/I> = 143) or no access to their medical records (n<\/I> = 23). As a result, 415 infertile couples who started a total of 1803 IUI cycles were eligible for the cost-effectiveness analyses.<\/p>\n
MAIN RESULTS AND THE ROLE OF CHANCE<\/p>\n
Optimal adherence to the guideline recommendations about sperm quality, the total number of IUI cycles and dose of human chorionic gonadotrophin was cost-effective with an incremental net monetary benefit between 645 and over 7500 per couple, depending on the recommendation and assuming a willingness to pay 20 000 for an ongoing pregnancy.<\/p>\n
LIMITATIONS, REASONS FOR CAUTION<\/p>\n
Because not all recommendations applied to all 415 included couples, smaller groups were left for some of the cost-effectiveness analyses, and one integrated analysis with all recommendations within one model was impossible.<\/p>\n
WIDER IMPLICATIONS OF THE FINDINGS<\/p>\n
Optimal guideline adherence in IUI care has substantial economic benefits when compared with suboptimal guideline adherence. For Europe, where over 144 000 IUI cycles are initiated each year to treat ~32 000 infertile couples, this could mean a possible cost saving of at least 20 million euro yearly. Therefore, it is valuable to make an effort to improve guideline development and implementation.<\/p>\n
STUDY FUNDING\/COMPETING INTEREST(S)<\/p>\n
This study was supported financially by the Netherlands Organisation for Health Research and Development, Grant No. 945-12-012, The Hague, The Netherlands. The funding source had no involvement in the study. The authors declare that they have no conflict of interest.<\/p>\n
Source: STUDY QUESTION Is optimal adherence to guideline recommendations in intrauterine insemination (IUI) care cost-effective from a societal perspective when compared with suboptimal adherence to guideline recommendations? SUMMARY ANSWER Optimal guideline adherence in IUI care has substantial economic benefits when compared … Continue reading
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