The long-term costs and effects of tubal flushing with oil-based versus water-based contrast during hysterosalpingography |
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| Authors: | Nienke van Welie Clarabelle T Pham Joukje van Rijswijk Kim Dreyer Harold R Verhoeve Annemieke Hoek Jan Peter de Bruin Annemiek W Nap Machiel HA van Hooff Mariëtte Goddijn Angelo B Hooker Anna P Gijsen Maaike AF Traas Jesper MJ Smeenk Alexander V Sluijmer Marieke J Lambers Gijsbertus A van Unnik Cornelia H de Koning Ben Willem J Mol |
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| Institution: | 1. Department of Reproductive Medicine, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Vrije Universiteit Amsterdam Amsterdam, the Netherlands;2. Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia;3. Department of Obstetrics and Gynaecology, OLVG, Amsterdam, the Netherlands;4. Department of Reproductive Medicine and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands;5. Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands;6. Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands;7. Department of Obstetrics and Gynaecology, Franciscus Hospital, Rotterdam, the Netherlands;8. Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;9. Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, the Netherlands;10. Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, the Netherlands;11. Department of Obstetrics and Gynaecology, Gelre Hospitals, Apeldoorn, the Netherlands;12. Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;13. Department of Obstetrics and Gynaecology, Wilhelmina Hospital, Assen, the Netherlands;14. Department of Obstetrics and Gynaecology, Dijklander Hospital, Hoorn, the Netherlands;15. Department of Obstetrics and Gynaecology, Alrijne Hospital, Leiden, the Netherlands;p. Department of Obstetrics and Gynaecology, Tergooi Hospital, Blaricum, the Netherlands;q. Department of Obstetrics and Gynaecology, Amstelland Hospital, Amstelveen, the Netherlands;r. Department of Obstetrics and Gynaecology, Bravis Hospital, Roosendaal, the Netherlands;s. Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia;t. Aberdeen Centre for Women''s Health Research, University of Aberdeen, Aberdeen, United Kingdom |
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| Abstract: | Research questionWhat are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)?DesignThis economic evaluation of a long-term follow-up of a multicentre randomized controlled trial involved 1119 infertile women randomized to HSG with oil- (n = 557) or water-based contrast (n = 562) in the Netherlands.ResultsIn the oil-based contrast group, 39.8% of women needed no other treatment, 34.6% underwent intrauterine insemination (IUI) and 25.6% had IVF/intracytoplasmic sperm injection (ICSI) in the 5 years following HSG. In the water-based contrast group, 35.0% of women had no other treatment, 34.2% had IUI and 30.8% had IVF/ICSI in the 5 years following HSG (P = 0.113). After 5 years of follow-up, HSG using oil-based contrast resulted in equivalent costs (mean cost difference –€144; 95% confidence interval CI] –€579 to +€290; P = 0.515) for a 5% increase in the cumulative ongoing pregnancy rate compared with HSG using water-based contrast (80% compared with 75%, Relative Risk (RR) 1.07; 95% CI 1.00–1.14). Similarly, HSG with oil-based contrast resulted in equivalent costs (mean cost difference –€50; 95% CI –€576 to +€475; P = 0.850) for a 7.5% increase in the cumulative live birth rate compared with HSG with water-based contrast (74.8% compared with 67.3%, RR 1.11; 95% CI 1.03–1.20), making it the dominant strategy. Scenario analyses suggest that the oil-based contrast medium is the dominant strategy up to a price difference of €300.ConclusionOver a 5-year follow-up, HSG with an oil-based contrast was associated with a 5% increase in ongoing pregnancy rate, a 7.5% increase in live birth rate and similar costs to HSG with water-based contrast. |
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