Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness?
Michael H. Hsieh, M.D., Ph.D., Maxwell V. Meng, M.D.,
and Paul J. Turek, M.D.
Department of Urology, University of California San Francisco
Objective
The relative impact of obstructive interval or female partner age on fertility using either ART or vasectomy reversal is not clear. To elucidate the impact of these variables on fertility, we applied Markov models to assess cost-effectiveness.
“……to better understand the relative impact of obstructive interval and female partner age on fertility after vasectomy, we applied Markov models to compare the cost effectiveness of ART versus vasectomy reversal. ”
– Dr. Paul Turek
Methods
Setting: Review of published literature and available ART outcome data. Patients: Simulation runs of 50,000 patients for each analysis. Interventions: Varying vasectomy obstructive interval and maternal age. Main Outcome Measures: Cost-effectiveness, willingness to pay (WTP), and Net Health Benefit (NHB).
Results
Base case analysis showed ART yields a higher pregnancy rate and higher cost than vasectomy reversal. Sensitivity analysis showed female age has a greater effect on cost-effectiveness than obstructive interval. At a WTP less than $65,000, vasectomy reversal is more cost-effective than ART. With increasing WTP, ART is more cost-effective over wider windows of female age.
Conclusions
Markov modeling of fertility after vasectomy suggests female age has more impact than vasectomy obstructive interval on cost effectiveness.
