OBJECTIVES: Cryopreservation of sperm is well-established practice for males at risk of fertility loss due to gonadotoxic treatment of malignancies or relevant non-malignant conditions. However the cost-effectiveness of this practice, in the context of the Australian healthcare system is unknown, and an estimate was sought to inform a public funding decision.

METHODS: A modelled decision analysis was constructed to estimate the cost-effectiveness of sperm cryopreservation in relevant males, compared with no fertility preservation measures being undertakenRelevant clinical outcomes that could be estimated from an evidence base were identified including; ‘achieving parenthood’ and ‘live births’. Costs associated with sperm collection, analysis, cryopreservation, storage, and downstream costs associated with achieving parenthood (assisted reproduction techniques, pregnancy and delivery) are all included, in 2017 AUD. Costs and outcomes, and incremental costs and outcomes are calculated over a cohort of 100 males and partners from the time of cryopreservation through to either use of, or discarding of, sperm. This occurs over a time horizon of up to ten years in adult males.

RESULTS: The clinical evidence, and therefore the model, indicate that fertility preservation through cryopreservation of sperm in post-pubertal males prior to gonadotoxic treatment has superior outcomes versus no fertility preservation. Males who cryopreserved were more likely to become a father compared with those who hadn’t; and those who survive cancer and achieve paternity have quality of life benefits. However additional costs are also incurred. For a typical male, the ICER was around $116,000 per additional parenthood, or $80,000 per additional live birth (due to couples having multiple children).

CONCLUSIONS: Although there is no broadly accepted threshold of acceptable cost-effectiveness with respect to achieving additional parenthood or live births, the economic analysis was informative and cryopreservation of sperm subsequently received public subsidisation in Australia.