Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: “Tap early and often” versus hospitalization
Objective
To compare the cost of two treatment regimens for moderate to severe ovarian hyperstimulation syndrome (OHSS): conservative inpatient versus outpatient management with paracentesis.
Design
A decision-tree mathematical model comparing conservative inpatient versus outpatient management of moderate to severe OHSS was created. The common final pathway of either management was resolution of OHSS. Sensitivity analyses were performed over the range of variables.
Main Outcome Measure(s)
Total management cost of OHSS.
Result(s)
The cost of conservative therapy including first-tier complications was $10,099 (range $9,655–$15,044). The cost of outpatient management with paracentesis was $1954 (range $788–$12,041). This resulted in an estimated cost savings of $8145 with outpatient management with paracentesis. One-way sensitivity analyses were performed. Varying the probability of admission after outpatient treatment still indicated that outpatient treatment was the most cost-effective (probability = 1.0, cost = $6110). Varying the duration of hospitalization with primary inpatient treatment was equal to outpatient treatment costs only at a stay of 0.71 days or shorter.
Conclusion(s)
Our model suggests early outpatient paracentesis for moderate to severe OHSS is the most cost-effective management plan when compared with traditional conservative inpatient therapy. The cost savings for outpatient management persisted throughout a variety of outcome probabilities.
Key Words: Ovarian hyperstimulation syndrome, OHSS, paracentesis, cost-analysis, outpatient management, ART, cost
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J.M.C. has nothing to disclose. B.J.Y. has nothing to disclose. M.B.H. has nothing to disclose. A.Y.A. has nothing to disclose. J.T.Q. has nothing to disclose. J.H.S. has nothing to disclose.
The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.
This research was supported in part by the Intramural Research Program of the Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
PII: S0015-0282(08)04047-8
doi:10.1016/j.fertnstert.2008.09.054
Published by Elsevier Inc.
