ABSTRACT
OBJECTIVES: To evaluate whether a prognosis-tailored triage of ART for couples with idiopathic infertility by using the Hunault prognostic model can decrease the cost of treatment without compromising the chance of live birth. STUDY DESIGN: This is a retrospective study conducted in an Australian fertility clinic. Couples seeking infertility consultation who were subsequently found to have idiopathic infertility after evaluation were included. We compared the costs per conception leading to live birth of the prognosis-tailored strategy with the immediate ART strategy, which generally reflects the current practice in Australian fertility clinics, over a 24-month period. In the prognosis-tailored strategy, for each couple, the prognosis for natural conception was assessed using the well-established Hunault model. Total cost of treatments were calculated as the sum of typical out-of-pocket and Australian Medicare cost (Australian national insurance scheme). RESULTS: We studied 261 couples. In the prognosis-tailored strategy, the total cost was $2,766,781 and the live birth rate was 63.9%. In contrast, the immediate ART strategy yielded a live birth rate of 64.4% with a total cost of $3,176,845. Implementing the prognosis-tailored strategy using the Hunault model saved $410,064 in total and $1,571 per couple. The incremental cost-effectiveness ratio (ICER) was $341,720 per live birth. CONCLUSION: In couples with idiopathic infertility, assessment of prognosis for natural conception using the Hunault model and delaying ART for 12 months in couples with favourable prognoses can considerably reduce costs without significantly compromising live birth rates.
Subject(s)
Infertility , Triage , Aged , Pregnancy , Female , Humans , Cost-Benefit Analysis , Retrospective Studies , Australia , National Health Programs , Infertility/therapy , Prognosis , Fertilization , Live Birth , Technology , Pregnancy Rate , Fertilization in VitroABSTRACT
RESEARCH QUESTION: What is the predictive value of serum anti-Müllerian hormone (AMH) level for natural conception and its clinical effect on subfertile couples? DESIGN: A retrospective cohort of ovulatory women seeking fertility consultation in a private fertility clinic. Couples who had an immediate indication for IVF were excluded. All natural conceptions leading to live birth before the start of assisted reproductive technology were followed within 12 months of the initial consultation. A prediction model was developed by updating the Hunault model with serum AMH to predict the probabilities of achieving a natural conception leading to live birth. RESULTS: A total of 325 couples were included in the final analysis. The estimated cumulative proability of achieving natural conception leading to live birth within 12 months was 20.9% (95% CI 12.9% to 28.2%). The categorical net reclassification improvement of AMH is 7.6%. For couples with a predicted chance of natural conception changed from poor (<30%) by the reference model to good (≥30%) by the updated model, the cumulative natural conception rate leading to live birth was 52.0%. For couples who had predicted chance of natural conception changed from good to poor by the updated model, the rate was 18.9%. CONCLUSIONS: The addition of serum AMH to the routine fertility work-up may improve prognosis-based treatment policy and help to prevent unnecessary costs and stress for couples. Prospective validation of the updated model with AMH is required before clinical application.
Subject(s)
Anti-Mullerian Hormone , Infertility , Female , Fertilization , Fertilization in Vitro , Humans , Infertility/therapy , Live Birth , Pregnancy , Pregnancy Rate , Retrospective StudiesABSTRACT
BACKGROUND: This short report aims to investigate changes in lifespan of Australian women with breast cancer using the novel average lifespan shortened (ALSS) measure METHODS: We obtained the mortality data of Australian women with breast cancer from the World Health Organization mortality database for the 1990-2015 period. We calculated the age-standardized rate (ASR) according to the World Standard Population. We estimated the ALSS as a ratio of years of life lost in relation to the expected lifespan to examine changes in lifespan of Australian women with breast cancer over the study period. RESULTS: Over a 25-year period, the ASR of breast cancer deaths decreased from 20.5 to 12.6 deaths per 100,000 women. We observed a decline in ALSS values from 24.0% of their lifespan in 1990 to 22.0% in 2015. CONCLUSION: The novel ALSS measure indicates an improvement of two percentage points in the lifespan of Australian women with breast cancer over the study.
