The long-term costs and effects of tubal flushing with oil-based versus water-based contrast during hysterosalpingography

Nienke Van Welie,Mariëtte Goddijn,Harold R Verhoeve,Annemieke Hoek,Angelo B Hooker,Anna P Gijsen,Velja Mijatovic,Clarabelle T Pham,Kim Dreyer,Jan Peter De Bruin,Joukje Van Rijswijk,Alexander V Sluijmer,Annemiek W Nap,Gijsbertus A Van Unnik,Catharina C.M Timmerman,Cornelis B Lambalk,A Mozes ,Jonathan Karnon ,Corry H De Koning ,M.j Lambers ,M.h.a Van Hooff ,Maaike A F Traas ,J.m.j Smeenk ,Ben W Mol

doi:10.1016/j.rbmo.2020.09.015

Abstract

Research questionWhat are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)? DesignThis economic evaluation of a long-term follow-up of a multicentre randomized controlled trial involved 1119 infertile women randomized to HSG with oil- (n = 557) or water-based contrast (n = 562) in the Netherlands. ResultsIn the oil-based contrast group, 39.8% of women needed no other treatment, 34.6% underwent intrauterine insemination (IUI) and 25.6% had IVF/intracytoplasmic sperm injection (ICSI) in the 5 years following HSG. In the water-based contrast group, 35.0% of women had no other treatment, 34.2% had IUI and 30.8% had IVF/ICSI in the 5 years following HSG (P = 0.113). After 5 years of follow-up, HSG using oil-based contrast resulted in equivalent costs (mean cost difference –€144; 95% confidence interval [CI] –€579 to +€290; P = 0.515) for a 5% increase in the cumulative ongoing pregnancy rate compared with HSG using water-based contrast (80% compared with 75%, Relative Risk (RR) 1.07; 95% CI 1.00–1.14). Similarly, HSG with oil-based contrast resulted in equivalent costs (mean cost difference –€50; 95% CI –€576 to +€475; P = 0.850) for a 7.5% increase in the cumulative live birth rate compared with HSG with water-based contrast (74.8% compared with 67.3%, RR 1.11; 95% CI 1.03–1.20), making it the dominant strategy. Scenario analyses suggest that the oil-based contrast medium is the dominant strategy up to a price difference of €300. ConclusionOver a 5-year follow-up, HSG with an oil-based contrast was associated with a 5% increase in ongoing pregnancy rate, a 7.5% increase in live birth rate and similar costs to HSG with water-based contrast.

Highlights

T raditionally, assessment of the Fallopian tubes is an important part of the fertility workup in infertile women
A costeffectiveness analysis of the H2Oil study showed that HSG using an oil-based contrast was a cost-effective strategy after a 6-month follow-up, with an incremental cost of US$8198 for an additional ongoing pregnancy compared with HSG using a water-based contrast
Study population Between February 2012 and October 2014, 1119 women were randomly assigned to HSG with oil-based contrast (n = 557) or water-based contrast (n = 562)

Summary

Introduction

T raditionally, assessment of the Fallopian tubes is an important part of the fertility workup in infertile women. A costeffectiveness analysis of the H2Oil study showed that HSG using an oil-based contrast was a cost-effective strategy after a 6-month (short-term) follow-up, with an incremental cost of US$8198 for an additional ongoing pregnancy compared with HSG using a water-based contrast (van Rijswijk et al, 2018). Considering these results, tubal flushing with oil-based contrast is gaining popularity, and two meta-analyses have recently been published on this topic (Fang et al, 2018; Wang et al, 2019)

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