Mortimer D, French S; Health Technology Assessment International. Meeting (1st : 2004 : Krakow, Poland).

Proc One HTA Health Technol Assess Int Meet 1st 2004 Krakow Pol. 2004; 1: 236.

Health Technology Assessment Unit, Monash Institute for Health Services Research, Clayton, Victoria, Australia.

OBJECTIVES: To determine whether between-trial heterogeneity with respect to relative risk of fertilisation for intracytoplasmic sperm injection (ICSI) as compared to in vitro fertilisation (IVF) can be explained by a learning curve or by between-trial variation in patient characteristics. METHODS: A systematic review of trials comparing fertilisation outcomes under ICSI and IVF (without surgical sperm retrieval) was conducted to inform the Medical Services Advisory Committee (MSAC) of Australia in its decision to allocate public funding for new technologies. Influence analysis was performed to determine whether the pooled relative risk was significantly different after deletion of selected trials. Meta-regression was used to identify associations between treatment effect and trial characteristics. RESULTS: Tests for heterogeneity suggested that different trials drew samples from different underlying distributions of treatment effect. The influence analysis indicated that the pooled relative risk was significantly different after excluding trials by Aboulghar et al (1995) and Hershlag et al (2002). Residual heterogeneity was minimised after adjusting for the covariates: publication date, maximum IVF insemination concentration, maximum % normal morphology, indication='unsuited for IVF' and indication= 'mixed'. The covariates publication date, indication='unsuited for IVF' and indication='mixed' were individually significant in explaining between-trial variation in treatment effect. DISCUSSION: The coefficients on individually significant covariates suggest that relative risk of fertilisation (ICSI versus IVF) varies inversely with publication date and is lower where indication='mixed' and higher where indication='unsuited for IVF'. While it is recognised that publication date might proxy for any number of unobserved variables, the possibility of a learning effect in favour of ICSI is not supported by the meta-regression.

Publication Types:

• Meeting Abstracts

Keywords:

• Association
• Australia
• Biomedical Research
• Clinical Trials as Topic
• Fertilization
• Fertilization in Vitro
• Humans
• In Vitro
• Insemination, Artificial, Homologous
• Learning
• Male
• Ovulation Induction
• Reproductive Techniques
• Sperm Injections, Intracytoplasmic
• Spermatozoa
• therapy
• hsrmtgs

UI: 103140865

From Meeting Abstracts