A decision analysis of treatments for nonobstructive azoospermia associated with varicocele

Fertility and Sterility
R LeeP N Schlegel

Abstract

To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI). Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers. Academic medical center. Simulation with a decision analytic model. Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI. Cost-effectiveness. Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery...Continue Reading

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Citations

Apr 23, 2013·International Urology and Nephrology·Saad Elzanaty
Jul 26, 2011·Asian Journal of Andrology·Mazen A GhanemGert R Dohle
Dec 18, 2012·Asian Journal of Andrology·Ali A Dabaja, Peter N Schlegel
Jan 7, 2016·Asian Journal of Andrology·Kelly A Chiles, Peter N Schlegel
Dec 19, 2015·Asian Journal of Andrology·Sandro C EstevesAshok Agarwal
Jan 29, 2011·Fertility and Sterility·Matthew A WillDana Ohl
Apr 20, 2010·The Journal of Urology·John W WeedinLarry I Lipshultz
Apr 1, 2016·Asian Journal of Andrology·Piyush PathakAlexander W Pastuszak
Aug 12, 2014·Spermatogenesis·Matthew WosnitzerMatthew P Hardy
Apr 20, 2016·Nature Reviews. Urology·Martin Kathrins, Craig Niederberger
Dec 2, 2014·PloS One·Gianpiero D PalermoZev Rosenwaks
Oct 30, 2016·The Journal of Urology·Koji ShiraishiHideyasu Matsuyama
Apr 17, 2019·Panminerva Medica·Chak-Lam ChoAshok Agarwal
May 2, 2018·Arab Journal of Urology·Mehmet G Sönmez, Ahmet H Haliloğlu
May 17, 2014·Reproductive Medicine and Biology·Masaki Kimura, Koichi Nagao
Aug 25, 2012·Current Opinion in Urology·Akanksha Mehta, Marc Goldstein

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