Evaluating Economic Studies in Reproductive Medicine

ABSTRACT

Healthcare professionals are under increasing pressure to stem the rise of healthcare costs and national healthcare expenditures. This has led to great interest in cost-effective therapy for patients. This article reviews the different types of economic analysis of medical practice and the components of a cost-effective analysis. It also reviews how to evaluate a cost-effectiveness paper and apply it to clinical practice. Economic analysis of a medical practice is a formal and quantitative method of comparing alternative strategies with respect to cost and outcomes. These analyses are frequently poorly performed, limiting their applicability to clinic practice. After reading this review, a physician should be better equipped to effectively evaluate economic analyses.

KEYWORDS

Cost-effectiveness - infertility - in vitro fertilization - economic analysis

REFERENCES

• 1 Doubilet P, Weinstein M C, McNeil B J. Use and misuse of the term “cost-effective” in medicine [occasional notes].  New Engl J Med . 1986;  314 253-256
• 2 Smith W J, Blackmore C C. Economic analyses in obstetrics and gynecology: a methodologic evaluation of the literature.  Obstet Gynecol . 1998;  91 472-478
• 3 Van Voorhis J B, Stovall D W, Allen B D, Syrop C H. Cost-effective treatment of the infertile couple.  Fertil Steril . 1998;  70 995-1005
• 4 Drummond M, Stoddart G, Labelle R, Cushman R. Health economics: an introduction for clinicians.  Ann Intern Med . 1987;  107 88-92
• 5 Eisenberg J M. Clinical economics: a guide to the economic analysis of clinical practices.  J Am Med Assoc . 1989;  262 2879-2886
• 6 Detsky A S, Naglie I G. A clinician's guide to cost-effectiveness analysis.  Ann Intern Med . 1990;  113 147-154
• 7 Callahan T L, Hall J E, Ettner S L, Christiansen C L, Greene M R, Crowley Jr W F. The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence.   N Engl J Med . 1994;  331 244-249
• 8 Chelmow D, Panzias A S, Kaurman G, Cetrulo C. Costs of triplet pregnancy.   Am J Obstet Gynecol . 1995;  172 677-682
• 9 Meltzer M I. Introduction to health economics for physicians.   Lancet . 2001;  358 993-998
• 10 Drummond M F, Jefferson T O. Guidelines for authors and peer reviewers of economic submissions to the BMJ.   BMJ . 1996;  313 275-283
• 11 O'Brien B J, Heyland D, Richardson S, Levine M, Drummond M F. Users' guides to the medical literature-how to use an article on economic analysis of clinical practice: what are the results and will they help me in caring for my patient?.  JAMA . 1997;  277 1802-1806
• 12 Collins J A, Burrows  E A, Willan A R. The prognosis for live birth among untreated infertile couples.   Fertil Steril . 1995;  64 22-28
• 13 Evers J LH, deHass H W, Land J A, Dumoulin J CM, Dunselman G AJ. Treatment-independent pregnancy rate in patients with severe reproductive disorders.  Hum Reprod . 1998;  13 1206-1209
• 14 Snick H KA, Snick T S, Evers J LH, Collins J A. The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study.  Hum Reprod . 1997;  12 1582-1588
• 15 Yin D, Forman H P. Health care cost-benefit and cost-effectiveness analysis: an overview.   J Vasc Interv Radiol . 1995;  6 311-320
• 16 Rein M S, Barbieri R L, Greene M F. The causes of high-order multiple gestation.  Int J Fertil . 1990;  35 154-156
• 17 Snick T S, Evers J LH, Collins J A. Kiely JL, Kleinman JC, Kiely M. Triplets and higher-order multiple births: time trends and infant mortality.  Am J Dis Child . 1992;  146 862-868
• 18 Levene M I, Wild J, Steer P. Higher multiple births and the modern management of infertility in Britain.   Br J Obstet Gynaceol . 1992;  99 607-613
• 19 Lipitz S, Reichman B, Paret G. et al . The improving outcome of triplet pregnancies.  Am J Obstet Gynecol . 1989;  161 1279-1284
• 20 Lipitz S, Frenkel Y, Watts C, Ben-Rafael Z, Barkai G, Reichman B. High-order multifetal gestation-management and outcome.   Obstet Gynecol . 1990;  76 215-218
• 21 Goldfarb J M, Austin C, Lisbona H, Peskin B, Clapp M. Cost-effectiveness of in vitro fertilization.   Obstet Gynecol . 1996;  87 18-21
• 22 Wapner R J, Davis G H, Johnson A. et al . Selective reduction of multifetal pregnancies.  Lancet . 1990;  335 90-93
• 23 Berkowitz R L, Lynch L, Lapinski R, Bergh P. First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.  Am J Obstet Gynecol . 1993;  169 17-21
• 24 Drummond M F, Richardson W S, O'Brien B J, Levine M, Heyland D. Users guides to the medical literature: how to use an article on economic analysis of clinical practice.   JAMA . 1997;  277 1552-1557
• 25 Goverde A J, McDonnell J, Vermeiden A PW, Schats R, Rutten F FH, Schoemaker J. Intrauterine insemination or in vitro fertilisation in idiopathic subfertility and male subfertility: a randomized trial and cost-effectiveness analysis.   Lancet . 2000;  355 13-18
• 26 Kassirer J P, Angell M. The Journal's policy on cost-effectiveness analyses [Editorial].  New Engl J Med . 1994;  331 669-670
• 27 Friedberg M, Saffran B, Stinson T J, Nelson W, Bennett C L. Evaluation of conflict of interest in economic analyses of new drugs used in oncology.   JAMA . 1999;  282 1453-1457
• 28 Van Voorhis J B, Stovall D W, Sparks A ET, Syrop C H, Allen B D, Chapler F K. Cost-effectiveness of infertility treatments: a cohort study.  Fertil Steril . 1997;  67 830-836
• 29 Van Voorhis J B, Barnett M, Sparks A ET, Syrop C H, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization.  Fertil Steril . 2001;  75 661-668
• 30 Ubel P A, DeKay M L, Baron J, Asch D A. Cost-effectiveness analysis in a setting of budget constraints: is it equitable?.  New Engl J Med . 1996;  334 1174-1177
• 31 Collins J A, Bustillo M, Visscher R D, Lawrence L D. An estimate of the cost of in vitro fertilization services in the United States in 1995.  Fertil Steril . 1995;  64 538-545