Use of frozen semen to avoid human immunodeficiency virus type 1 transmission by donor insemination: a cost-effectiveness analysis

Reappraisal of current guidelines mandating frozen-thawed semen. Cost-effectiveness analysis comparing the use of frozen semen with the use of fresh semen from the same donors without a second antibody test. A Markov model computer simulation. A theoretical cohort of 80,000 women whose husbands are azoospermic. Simulation with calculation of costs and payoffs. Total lifetime direct health care costs, costs per live birth, life expectancy, quality adjusted life years (QALY), marginal cost effectiveness ($/QALY). If all 80,000 women who undergo donor insemination in the United States each year chose to use fresh semen from donors screened according to the current practice guidelines but without semen cryopreservation, there would be 8,881 more births and the mean cost per live birth would be $15,501 less. One recipient would become infected with HIV-1 every 5.1 years, during which time over 180,000 noninfected children would be born. The average life expectancy of recipients would be reduced by 2 days, but their quality-adjusted life expectancy would increase by over 1 month. Medicolegal costs to physicians would need to exceed $780 million per infection to equalize the cost effectiveness of the fresh and frozen policies. The guidelines should be revised to allow the use of fresh semen by informed recipients.