Cost effectiveness of ovarian reserve testing in in vitro fertilization: a Markov decision- analytic model  Lobke M. Moolenaar, M.D., Frank J.M. Broekmans, Ph.D., M.D., Jeroen van Disseldorp, Ph.D., M.D., Bart C.J.M. Fauser, Ph.D., M.D., Marinus J.C. Eijkemans, Ph.D., M.D., Peter G.A. Hompes, Ph.D., M.D., Fulco van der Veen, Ph.D., M.D., Ben Willem J. Mol, Ph.D., M.D.  Fertility and Sterility  Volume 96, Issue 4, Pages 889-894.e2 (October 2011) DOI: 10.1016/j.fertnstert.2011.06.072 Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Simplistic overview of the Markov model. Represents a decision node, represents a label node, represents a chance node, represents a Markov node∗, represents a terminal node. ∗A Markov node allows events to recur over time. Fertility and Sterility 2011 96, 889-894.e2DOI: (10.1016/j.fertnstert.2011.06.072) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Incremental cost-effectiveness ratio scatterplot of the probabilistic sensitivity analysis. The word incremental refers to the difference between two alternatives (e.g., scenario X minus the scenario IVF until the age of 41 years), Dose individualization increases live-birth rates with comparable costs relative to IVF until the age of 41. Exclusion of the expected poor responder decreases the costs marginally but also creates a loss in effectiveness compared with IVF until the age of 41 years. No treatment gives a reduction in costs and live births compared with IVF until the age of 41 years. The incremental cost-effectiveness ratios (ICER) lines of €10,000 and €20,000 represents the ratio per extra live birth compared with the tested scenarios. Fertility and Sterility 2011 96, 889-894.e2DOI: (10.1016/j.fertnstert.2011.06.072) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Cost-effectiveness acceptability curve. The acceptability curve indicates the probability that an intervention is cost effective compared with the alternative, given the observed data, for a range of willingness-to-pay values. The cost-effectiveness acceptability curves show that if the willingness to pay is below €10,900, no treatment has the highest probability to be cost effective. If society is willing to pay more than €10,900, the scenario of dose individualization according to ovarian reserve has the highest probability to be the most cost-effective scenario. Fertility and Sterility 2011 96, 889-894.e2DOI: (10.1016/j.fertnstert.2011.06.072) Copyright © 2011 American Society for Reproductive Medicine Terms and Conditions