After 3 years, the cumulative pregnancy rate was 99.4% with immediate ART and 95.3% with vasectomy reversal first.
The mean costs were $31,399 with immediate ART and $29,274 with vasectomy reversal first.
An incremental cost-effectiveness ratio to compare the two strategies was not calculated. However, the authors estimated, that at a willingness-to-pay (WTP) of $65,000 or less, vasectomy reversal was the preferred option, while at higher WTP values ART was more cost-effective.
A tornado analysis showed that maternal age had a substantial impact on cost-effectiveness which was much stronger than obstructive interval. Even with small increases in maternal age, the net health benefit decreased for both options, suggesting a lower cost-effectiveness. In general, ART was more cost-effective as maternal age increased. For example, at a WTP of $100,000, ART was preferred to vasectomy reversal when maternal age was between 33.1 and 38 years. However, the model input with the strongest impact on the cost-effectiveness results was the IVF pregnancy rate. Other model inputs that had an impact on the base-case results were the cost per IVF cycle and vasectomy reversal, pregnancy rate after vasectomy reversal, length of time that couples spent on infertility treatment, and interval between IVF cycles.