April 5th, 2020

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Cost-Benefit Analysis of Hysteroscopic Polypectomy Before Controlled Ovarian Hyperstimulation and Intrauterine Insemination in Infertile Women
Authors:  Lauren W. Sundheimer, M.D., M.S., Anupama Kathiresan, M.D., Daniel Dumesic, M.D., Ram Parvataneni, M.D., M.P.H., and Mousa Shamonki, M.D.
  OBJECTIVE: To examine the cost benefit of performing hysteroscopic polypectomy (HP) in infertile women with endometrial polyp(s) before controlled ovarian hyperstimulation with intrauterine insemination (COH/IUI).

STUDY DESIGN: Decision analytic model comparing costs and clinical outcomes.

RESULTS: HP and COH/IUI costs ranged from $537–$12,530 and $800–$7,600, respectively. Performing an HP before COH/IUI lowered fertility cost by $7,652 per clinical pregnancy. When COH/IUI costs remained constant, HP was most cost beneficial when the cost of HP was below a threshold value of $9,452. When HP costs remained constant, the threshold value at which HP was no longer cost beneficial was at COH/IUI costs below $704. The cost benefit was greatest when an office-based HP is performed.

CONCLUSION: HP before COH/IUI is more cost beneficial than fertility treatment alone, particularly when office-based hysteroscopy is performed.
Keywords:  artificial insemination; controlled ovarian hyperstimulation; cost-benefit; cost-benefit analysis; endometrial polyp; fertilization in vitro; hysteroscopic polypectomy; infertility; intrauterine insemination; ovarian stimulation; ovulation induction.
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