輸精管結紥後無精症之處置

輸精管結紥後無精症之病患施行輸精管重接手術之比施行睪丸(TESE, TESA)或副睪(MESA)取精成功率為低&花費較高
輸精管結紥後無精症之病患施行輸精管重接手術之接通率約為70%
http://humrep.oxfordjournals.org/content/23/9/2043.long


Hum Reprod. 2008 Sep;23(9):2043-9. Epub 2008 Jun 13.

A decision analysis of treatments for obstructive azoospermia.

Lee R, Li PS, Goldstein M, Tanrikut C, Schattman G, Schlegel PN.

Source

James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th St., Starr 900, New York, NY 10021, USA.

Abstract

BACKGROUND:

Treatments for post-vasectomy obstructive azoospermia include vasectomy reversal, microsurgical epididymal sperm aspiration (MESA) or percutaneous testicular sperm extraction (TESE) with IVF/ICSI. We examined the cost-effectiveness of these treatments.

METHODS:

A decision analytic model was created to simulate treatment. Outcome probabilities were derived from peer-reviewed literature and the Society for Assisted Reproductive Technologies database. Procedural costs were derived from a sampling of high-volume IVF centers and the Medicare Resource Based Relative Value Scale. Indirect costs of complications, lost productivity and multiple gestation pregnancies were considered. Sensitivity analyses were performed.

RESULTS:

Vasectomy reversal was more cost-effective than either MESA or TESE under all probability conditions. In 1999, vasectomy reversal demonstrated superior cost-effectiveness to TESE and MESA ($19,633 versus $45,637 and $48,055, respectively, equivalent to $25,321 versus $58,858 and $61,977 in 2005 dollars). In 2005, vasectomy reversal ($20,903) remained the most cost-effective treatment over TESE ($54,797) and MESA ($56,861). The cost-effectiveness of all treatments improved over projections by inflation. The relative cost-effectiveness of the therapies was unchanged over time.

CONCLUSIONS:

Vasectomy reversal appears more cost-effective than percutaneous TESE and MESA for treatment of obstructive azoospermia when the impact of indirect costs is considered. The absolute cost-effectiveness of all therapies improved over time. These results may be tailored with institution-specific data to allow more individualized results.