Objective: To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG).
Design: Economic evaluation alongside a multicenter randomized trial.
Setting: Hospitals.
Patient(s): Infertile women with an ovulatory cycle, 18-39 years of age, low risk of tubal pathology.
Intervention(s): Use of oil-based versus water-based contrast during HSG.
Main outcome measure(s): Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs).
Result(s): A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth.
Conclusion(s): Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology.
Clinical trial registration number: Dutch Trial Register, NTR 6577 (www.trialregister.nl).
Keywords: Cost-effectiveness; hysterosalpingography (HSG); oil-based contrast; ongoing pregnancy; water-based contrast.
Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.