{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T06:37:56Z","timestamp":1769841476011,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,1,18]],"date-time":"2013-01-18T00:00:00Z","timestamp":1358467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost\u2010effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cost\u2010effectiveness analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Decision analytic framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Computer\u2010simulated cohort of subfertile women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (<jats:styled-content style=\"fixed-case\">HSG<\/jats:styled-content>), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) <jats:styled-content style=\"fixed-case\">HSG<\/jats:styled-content> and a diagnostic laparoscopy (<jats:styled-content style=\"fixed-case\">DL<\/jats:styled-content>) in case <jats:styled-content style=\"fixed-case\">HSG<\/jats:styled-content> does not prove tubal patency, followed by tailored treatment; and (6) <jats:styled-content style=\"fixed-case\">DL<\/jats:styled-content> followed by tailored treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Expected cumulative live births after 3\u00a0years. Secondary outcomes were cost per couple and the incremental cost\u2010effectiveness ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For a 30\u2013year\u2010old woman with otherwise unexplained subfertility for 12\u00a0months, 3\u2013year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were \u20ac0, \u20ac6968, \u20ac5063, \u20ac5410, \u20ac5405 and \u20ac6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost\u2010effectiveness ratios compared with scenario 1 (reference strategy), were \u20ac26,541, \u20ac19,046, \u20ac20,372, \u20ac20,150 and \u20ac23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The most cost\u2010effective scenario is to perform no diagnostic tubal tests and to delay <jats:italic>in vitro<\/jats:italic> fertilisation (<jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content>) treatment for at least 12\u00a0months for women younger than 38\u00a0years old, and to perform no tubal tests and start immediate <jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content> treatment from the age of 39\u00a0years. If an invasive diagnostic test is planned, <jats:styled-content style=\"fixed-case\">HSG<\/jats:styled-content> followed by tailored treatment, or a <jats:styled-content style=\"fixed-case\">DL<\/jats:styled-content> if <jats:styled-content style=\"fixed-case\">HSG<\/jats:styled-content> shows no tubal patency, is more cost\u2010effective than <jats:styled-content style=\"fixed-case\">DL<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12121","type":"journal-article","created":{"date-parts":[[2013,1,18]],"date-time":"2013-01-18T10:32:47Z","timestamp":1358505167000},"page":"583-593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cost\u2010effectiveness of tubal patency tests"],"prefix":"10.1111","volume":"120","author":[{"given":"HR","family":"Verhoeve","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Onze Lieve Vrouwe Gasthuis Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LM","family":"Moolenaar","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Medicine Academic Medical Centre Amsterdam the Netherlands"},{"name":"Department of Obstetrics &amp; Gynaecology Vrije Universiteit Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Hompes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Vrije Universiteit Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"van der Veen","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Medicine Academic Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BWJ","family":"Mol","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Medicine Academic Medical Centre Amsterdam the Netherlands"},{"name":"Department of Clinical Epidemiology and Biostatistics Academic Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,1,18]]},"reference":[{"issue":"5","key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"s264","DOI":"10.1016\/j.fertnstert.2006.08.041","article-title":"Optimal evaluation of the infertile female","volume":"86","author":"ASRM Practice Committee Reports","year":"2006","journal-title":"Fertil Steril"},{"key":"e_1_2_6_3_1","unstructured":"National Institute for Clinical Excellence.Fertility: assessment and treatment for people with fertility problems. 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