April 25th, 2019

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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
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