September 27th, 2020

A full text version of this article is available.
To access article obtain online access here or login
Options for Assisted Reproduction in Young Women with Uterine Cancer: A Cost-Effectiveness Analysis
Authors:  Monjri M. Shah, M.D., Bruce D. Pier, M.D., Janet M. Bouknight, M.D., J. Michael Straughn, Jr., M.D., and Charles A. Leath, III, M.D., MSPH
  OBJECTIVE: Type I endometrial cancer (EC) prevalence in young women is rising. Fertility preservation is an option. We performed a cost-effectiveness analysis to examine reproductive options in young EC patients.

STUDY DESIGN: A decision analysis model com-pared 4 strategies for achieving pregnancy in young patients with progestin-treated stage I EC: (1) unassisted pregnancy attempts× 12 months, ovulation induction with either (2) oral agents×6 cycles or (3) gonadotropins×3 cycles, and (4) in vitro fertilization (IVF)×3 cycles. Effectiveness was defined as pregnancy rate at 12 months. Cost-effectiveness ratio was defined as cost per pregnancy (CPP). Incremental cost-effectiveness ratios (ICERs) were calculated.

RESULTS: If the estimated 1,100 eligible patients pursued unassisted pregnancy, 165 pregnancies would cost $79,200, with a CPP of $480. Oral agents resulted in 388 additional pregnancies, costing nearly $2.6 million (M), with a CPP of $4,655 and an ICER of $6,428. Gonadotropins were slightly more effective, with an ICER of over $18,000. IVF resulted in 917 pregnancies, costing $25.8M, with a CPP of $28,093 and an ICER of $81,031 per additional pregnancy.

CONCLUSION: No strategy was clearly the most cost-effective. Reproductive options for early-stage EC patients should be individualized, and oncofertility consultation is paramount to optimize care.
Keywords:  adult, anovulation, cost effectiveness, endometrial cancer, female, fertility preservation, gynecologic diseases, infertility, obesity, oncofertility, pregnancy, uterine cancer
  Acrobat Reader 7.0 is recommended to properly view and print the article.
Reader can be downloaded from