The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction

Abstract

Objectives: Opportunistic salpingectomy is a cost-effective strategy recommended for ovarian cancer (OvCa) risk reduction at the time of gynecologic surgery in women who have completed childbearing. We aimed to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation (TL) during cesarean delivery. Study Design: A cost-effectiveness analysis using decision modeling to compare opportunistic salpingectomy to TL at the time of cesarean using probabilities of procedure completion derived from a trial. Probability and cost inputs were derived from local data and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2017 U.S. dollars per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. One- and two-way sensitivity analyses were performed for all variables. A probabilistic sensitivity analysis determined the proportion of simulations in which each strategy would be cost-effective. Results: Opportunistic salpingectomy was cost-effective compared to TL with an ICER of $26,616 per QALY. In 10,000 women desiring sterilization with cesarean, opportunistic salpingectomy would result in 17 fewer OvCa diagnoses, 13 fewer OvCa deaths, and 25 fewer unintended pregnancies compared to TL – with an associated cost increase of $4.7 million. The model was sensitive only to OvCa risk reduction from salpingectomy and TL. Opportunistic salpingectomy was not cost-effective if its cost was >$3,163.74 more than TL, if the risk-reduction of salpingectomy was <41%, or if the risk-reduction of TL was >46%. In probabilistic sensitivity analysis opportunistic salpingectomy was cost effective in 75% of simulations. Conclusions: In women undergoing cesarean with sterilization, opportunistic salpingectomy is likely cost-effective and may be cost-saving in comparison to TL for OvCa risk reduction.

Salpingectomy versus Tubal Occlusion for Permanent Contraception during Cesarean Delivery: Outcomes and Physician Attitudes

“…Perceived medical costs did not seem to affect study physician behavior as 87% believed salpingectomy to be cost-neutral relative to tubal occlusion. Congruently, studies have found the practice to be either costneutral [5] or cost-saving [8] when compared with tubal occlusion. Most low rate salpingectomy performers completed residency training at the same institution (University of Cincinnati Medical Center) plausibly underlining the impact of residency training on physician practices.…”

Opportunistic salpingectomy at cesarean delivery in Japan: A questionnaire for registered physicians of the MFICU Liaison Council

“…Recent studies confirmed that salpingectomy at cesarean delivery was superior to tubal ligation for reducing the risk of ovarian cancer. [3][4][5] In a case-control study from Denmark that targeted cases of epithelial ovarian cancer (n = 13,241) and controls (n = 194,689), salpingectomy and tubal ligation reduced the risk of ovarian cancer (for salpingectomy: odds ratios [OR] and 95% confidence interval [CI], 0.58 [0.36-0.95]; for tubal ligation: OR and 95% CI, 0.87 [0.78-0.98]), suggesting the superiority of salpingectomy to tubal ligation. 3) Subramaniam et al estimated that salpingectomy at cesarean delivery reduced the incidence of ovarian cancer and number of deaths from ovarian cancer per 10,000 people by 17 and 13 per year, respectively, from those with tubal ligation.…”

“…2) Recent studies in Obstetrics confirmed that salpingectomy at cesarean delivery is superior to tubal ligation as sterilization for reducing the risk of ovarian cancer and is also more cost-effective. [3][4][5] To the best of our knowledge, the frequency at which opportunistic salpingectomy is performed, how many physicians hope to conduct this procedure at cesarean delivery, and the steps taken to achieve the goal of performing opportunistic salpingectomy at cesarean delivery currently remain unknown in Japan. Therefore, we herein conducted a questionnaire survey to be completed by registered physicians of the Maternal Fetal Intensive Care Unit (MFICU) Liaison Council in Japan.…”

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy

“…The disutility rate is then applied over the expected time course of that health state. Within this analysis, a one-year time horizon was assumed for all utility values, outcomes and costs, consistent with prior literature (15)(16)(17); given this timeframe, no discounting is required.…”