Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: “Tap early and often” versus hospitalization  John M. Csokmay, M.D., Belinda J. Yauger, M.D., Melinda B. Henne, M.D., M.S., Alicia Y. Armstrong, M.D., M.H.S.C.R., John T. Queenan, M.D., James H. Segars, M.D.  Fertility and Sterility  Volume 93, Issue 1, Pages 167-173 (January 2010) DOI: 10.1016/j.fertnstert.2008.09.054 Copyright © 2010 Terms and Conditions

Figure 1 Cost-effective decision tree for management of OHSS. The initial arm is a decision node between inpatient or outpatient management. After deciding treatment route, all subsequent outcomes were based on probabilities extracted from literature or institutional retrospective chart review. The final outcome for either treatment arm was resolution of OHSS. Cost estimates from 2007 were used. Costs listed in each box of the outline are the total costs per patient enrolled for that treatment arm and outcome. Fertility and Sterility 2010 93, 167-173DOI: (10.1016/j.fertnstert.2008.09.054) Copyright © 2010 Terms and Conditions

Figure 2 (A) Cost variation through a range of inpatient hospital stay lengths. The cost of outpatient management arm is held constant in this one-way sensitivity analysis. Axes: x = length of inpatient hospitalization in days, y = total cost of treatment (U.S. dollars). The intersection of the lines demonstrates cost equivalence between two treatment arms, which occurs at less than 1 day of hospitalization. (B) Cost of primary outpatient management of OHSS through a range of probabilities of hospital admission. Inpatient management cost is held constant in this one-way sensitivity analysis. Axes: x = probability of hospital admission in primary outpatient treatment arm, y = total cost of treatment (U.S. dollars). The point of intersection between the two lines would represent cost equivalence, but, as shown, inpatient management remains more costly, even at high probabilities for hospitalization. Fertility and Sterility 2010 93, 167-173DOI: (10.1016/j.fertnstert.2008.09.054) Copyright © 2010 Terms and Conditions