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

N van Welie, Clarabelle T Pham, J van Rijswijk, K Dreyer, Harold R. Verhoeve, Annemieke Hoek, Jan Peter de Bruin, Annemiek W. Nap, Machiel H.A. van Hooff, M Goddijn, AB Hooker, Anna P. Gijsen, Maaike A.F. Traas, Jesper M. J. Smeenk, Alexander V. Sluijmer, MJ Lambers, Gijsbertus A. Van Unnik, Cornelia H. de Koning, Alexander Mozes, Catharina C.M. TimmermanCB Lambalk, Jonathan D. Karnon, V Mijatovic, Ben Willem Mol

Research output: Contribution to journalArticleAcademicpeer-review


Research question: What are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)? Design: This 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. Results: In 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. Conclusion: Over 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.

Original languageEnglish
Pages (from-to)150-157
Number of pages8
JournalReproductive BioMedicine Online
Issue number1
Early online date2020
Publication statusPublished - Jan 2021

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