The long-term costs and effects of tubal flushing with oil-based versus water-based contrast during hysterosalpingography. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: van Welie, Nienke; Pham, Clarabelle T.; van Rijswijk, Joukje; Dreyer, Kim; Verhoeve, Harold R.; Hoek, Annemieke; de Bruin, Jan Peter; Nap, Annemiek W.; van Hooff, Machiel H.A.; Goddijn, Mariëtte; Hooker, Angelo B.; Gijsen, Anna P.; Traas, Maaike A.F.; Smeenk, Jesper M.J.; Sluijmer, Alexander V.; Lambers, Marieke J.; van Unnik, Gijsbertus A.; de Koning, Cornelia H.; Mozes, Alexander; Timmerman, Catharina C.M.; Lambalk, Cornelis B.; Karnon, Jonathan D.; Mijatovic, Velja; Mol, Ben Willem J.
• Is Part Of: Reproductive biomedicine online. Volume 42:Issue 1(2021)
• Page Start: 150
• Page End: 157
• Publication Date: 2021-01
• Subjects: Cost-Effectiveness -- Female Infertility -- Hysterosalpingography -- Oil-based Contrast -- Ongoing Pregnancy -- Water-based Contrast; Human reproductive technology -- Periodicals; Human embryo -- Periodicals; Reproduction -- Periodicals; 616.692
• DOI: 10.1016/j.rbmo.2020.09.015
• Languages: English
• ISSNs: 1472-6483

Abstract

Abstract: Research question: What are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)? Design: This 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. Results: In 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. Conclusion: Over 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.