Human Reproduction, Vol 13, 1200-1205, Copyright © 1998 by Oxford University Press
B VanderLaan, V Karande, C Krohm, R Morris, D Pratt and N Gleicher
Of 98 retrospectively selected patient couples insured under one scheme
(group I) who, based on performance of a hysterosalpingogram (HSG), were
assumed to be under active infertility care, 96 were confirmed as
infertile. These were matched by date, patient age and time of HSG to 96
patients under infertility care (group II). Both patient populations were
then prospectively evaluated for outcome and cost of treatment. Total
physician charges for groups I and II were similar. However, charges per
achieved clinical pregnancy were higher in group I than group II since
group I patients demonstrated a lower pregnancy rate (28/96, 29%) than
group II patients (41/96, 43%) (P=0.05). Within group I, pregnancy rates
were identical, whether treatment was provided by generalists or
subspecialists. In group II, all care was provided by specialists. The
number of days of treatment did not vary between groups I and H, though
generalists in group I provided significantly fewer treatment days than
specialists in either group I (P=0.003) or in group II (P=0.021). This was
primarily due to a significantly higher patient drop-out rate in group I
patients, and especially amongst those who received care from generalists
(P < 0.0019). Group I patients also encountered significantly more
surgical procedures than group H patients (P=0.0016). If physician charges
are discounted and customary surgical facility costs are added, the actual
cost structure for fertility care in group I patients was dramatically
higher than in group II patients. The most cost-effective format to provide
infertility care of high quality appears to be a managed care setting in
which subspecialists provide a majority of care and in which patient choice
is restricted to those subspecialists.
ARTICLES
Cost considerations with infertility therapy: outcome and cost comparison between health maintenance organization and preferred provider organization care based on physician and facility cost
Blue Cross and Blue Shield of Illinois, and the Division of Reproductive Endocrinology and Infertility, the Center for Human Reproduction-Illinois, Chicago 60610, USA.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Brandes, J.O.M. van der Steen, S.B. Bokdam, C.J.C.M. Hamilton, J.P. de Bruin, W.L.D.M. Nelen, and J.A.M. Kremer When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population Hum. Reprod., December 1, 2009; 24(12): 3127 - 3135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Daya Life table (survival) analysis to generate cumulative pregnancy rates in assisted reproduction: are we overestimating our success rates? Hum. Reprod., May 1, 2005; 20(5): 1135 - 1143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Philips, M. Barraza-Llorens, and J. Posnett Evaluation of the relative cost-effectiveness of treatments for infertility in the UK Hum. Reprod., January 1, 2000; 15(1): 95 - 106. [Abstract] [Full Text] [PDF]
|
|