A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting

Abstract

AbstractIntroductionVaricocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy.MethodsRetrospective cost‐outcome study of patients treated by embolisation between January 2018 and 2023. A bottom‐up approach was used to calculate procedure costs whereas a top‐down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation.ResultsCosting data from 18 patients were included, of median age 33.5 years (range 26–60) and median varicocoele grade 2.5 (range 1–3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non‐procedural, ward and peri‐procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691–7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207).ConclusionTotal varicocoele embolisation cost and the cost per‐pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low‐cost pinhole procedure.