Options for Assisted Reproduction in Young Women with Uterine Cancer A Cost-Effectiveness Analysis

OBJECTIVE: Type I endometrial cancer (EC) prevalence in young women is rising. Fertility preservation is an option. We performed a cost-effectiveness analysis to ex- amine reproductive options in young EC patients. STUDY DESIGN: A decision analysis model compared 4 strategies for achieving pregnancy in young patients with progestin-treated stage I EC: (1) unassisted pregnancy attempts x 12 months, ovulation induction with either (2) oral agents x 6 cycles or (3) go-nadotropins x 3 cycles, and (4) in vitro fertilization (IVF) x 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. Go-nadotropins 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.