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Three different scenarios were used sequentially, relating to comparisons of primary offer of IVF with three possible modalities of IUI: U-IUI, S-IUI (gonadotrophin-stimulated) and C-IUI (clomifene-stimulated).
In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy), costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI.
Our study indicates that for couples with unexplained or mild male factor subfertility, a primary treatment offer of any modality of IUI instead of primary offer of IVF is cost-ineffective, and therefore associated with considerable opportunity costs.
For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, the cost of primary offer of one full cycle of IVF would be £321,700, with a cost-effectiveness ratio of £12,600/live birth-producing pregnancy (Table 2).
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We therefore constructed a mathematical model to evaluate the cost-effectiveness of provision of IUI followed by IVF compared to primary offer of IVF for patients who according to NICE are eligible for both treatment strategies.
Table 3 shows the opportunity costs, in terms of number of additional IVF cycles that could be purchased by the cost difference of IUI (followed by IVF) compared to primary offer of IVF alone.
Compared to primary offer of IVF, the ICER for offer of one to six cycles of U-IUI followed by IVF (for IUI failures) would be £18,000 to £14,200 per live birth-producing pregnancy.
If the true estimate is lower, any bias introduced from this assumption would have favoured the cost-effectiveness of U-IUI, and would have made IVF less cost effective, i.e. if a lower LBR value for U-IUI was used, the results would have been even more favourable for primary offer of IVF as the preferred treatment strategy.
Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies.
The curriculum structure of Bachelor of Science Education (Primary) offered by the ITE is more of general science content.
For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional £174,200 and £438,000, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com