Economic evaluation of infertility treatment for tubal disease.

PURPOSE: The number of published studies comparing cost-effectiveness of tubal surgery and IVF treatment is limited, in part because of the difficulties of conducting randomized trials, given that IVF is now a clinically accepted treatment and the decision to offer surgery or IVF is often dictated by the severity of the tubal disease and by the availability of the methods. The aim of this study was to compare the costs of our policy of offering tubal surgery to patients with mild or moderate tubal disease with the cost of offering IVF to these and severe tubal disease. METHODS: In this retrospective cohort study patients with tubal pathology as the sole reason for their infertility were included: 61 patients in the tubal surgery group and 464 patients in the IVF group. The delivery rates and costs per delivery were compared. RESULTS: Delivery rates were 28% in the tubal surgery group within 2 years of follow-up and 52% in the IVF group that involved up to three cycles of treatment. This economic evaluation demonstrated only small differences in the average cost when considering the cost per delivery. CONCLUSIONS: With a policy involving strict selection of patients, tubal surgery will continue to have a role in the treatment of infertility.

Effects of the cannabimimetic fatty acid derivatives 2-arachidonoylglycerol, anandamide, palmitoylethanolamide and methanandamide upon IgE-dependent antigen-induced beta-hexosaminidase, serotonin and TNF alpha release from rat RBL-2H3 basophilic leukaemic cells.

There are conflicting reports in the literature as to whether palmitoylethanolamide affects the function of mast cell-related cell lines in vitro, in contrast to the well-documented effects of this compound upon mast cell function in vivo. In the present study, we have reinvestigated the effects of palmitoylethanolamide upon antigen-induced release of [3H]serotonin and beta-hexosaminidase from rat basophilic leukemia RBL-2H3 cells and compared these effects with those of 2-arachidonoylglycerol, anandamide and R1-methanandamide. RBL-2H3 cells were sensitized with a monoclonal anti-DNP IgE, after which they were stimulated with antigen (DNP-HSA). Palmitoylethanolamide produced a small, but significant reduction in antigen-stimulated [3H]serotonin release at high concentrations, whereas anandamide was without effect. In contrast, 2-arachidonoylglycerol and methanandamide increased the antigen-stimulated release of both [3H]serotonin and beta-hexosaminidase. It is concluded that in RBL-2H3 cells, these cannabimimetic fatty acid derivatives do not have potent stabilizing effects upon antigen-induced degranulation.

A cost comparison of infertility treatment for clomiphene resistant polycystic ovary syndrome.

BACKGROUND: The study compares treatment outcome and costs of ovulation induction cycles and in vitro fertilization cycles in infertile women with clomiphene resistant polycystic ovary syndrome. METHODS: Twenty-eight infertile women with clomiphene resistant polycystic ovary syndrome referred to a university clinic were prospectively randomized to ovulation induction or in vitro fertilization. Forty-one ovulation induction cycles and thirty in vitro fertilization cycles were performed. Mann-Whitney U-test was used for between group comparisons and frequencies were compared with Fisher's exact test. RESULTS: More pregnancies per completed cycle were noted in the in vitro fertilization group than in the ovulation induction group. Drug costs were not much higher in the in vitro fertilization group but treatment costs were higher due to the additional costs of ovum pick up and embryo transfer. The cost per pregnancy was about twice as high in the ovulation induction group as in the in vitro fertilization group. The cost per term pregnancy including delivery was 1.6 times higher in the ovulation induction group. CONCLUSION: For a group of obese women with clomiphene resistant polycystic ovary syndrome, in vitro fertilization seems a cost-effective treatment.

Financing of IVF/ET in the Nordic countries.

BACKGROUND: The need for calculations of costs of health care has increased during the last few years. When priorities within the national health services in the five Nordic countries are discussed, treatment of infertility is often one of the issues. AIM AND METHODS: The aim of this study was to evaluate cost effectiveness and calculate the proportion of publicly financed in-vitro fertilization/embryo transfers in the Nordic countries. The mean direct and indirect costs of the treatments were calculated in both public and private clinics. The total cost of in-vitro fertilization was calculated and compared with the proportion financed through the national health services in the five countries. RESULTS: The cost analysis showed a direct and indirect cost of 3,300 Pounds per started treatment and 12,700 Pounds per term pregnancy for the whole Nordic material. The publicly financed costs were calculated at 27,342,300 Pounds, which is 66% of the total cost for in-vitro fertilization treatments. When these costs were compared with the total cost of health care in the countries, the proportion used for in-vitro fertilization treatments was between 0.08 and 0.16%. CONCLUSION: It will be difficult for the national health services in the five countries to make large savings by limiting the number of treatments financed within the system.