TOPLINE:

Salpingectomy for permanent contraception yields an incremental cost-effectiveness ratio of $143,769 per quality-adjusted life-year (QALY) gained compared with vasectomy. The procedure prevents 6085 cases of ovarian cancer and 4921 deaths annually but fails to meet the $100,000 willingness-to-pay threshold.

METHODOLOGY:

• Researchers developed a decision tree model using TreeAge to evaluate cost effectiveness of vasectomy compared with salpingectomy for a hypothetical cohort of 800,000 people.
• Analysis included QALYs as the effectiveness measure, with the willingness-to-pay threshold set at $100,000 per QALY gained or lost.
• Investigators completed a probabilistic sensitivity analysis with 10,000 simulations and created a cost-effectiveness acceptability curve.
• Secondary outcomes encompassed the number of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths.

TAKEAWAY:

• Salpingectomy was not a cost-effective strategy, with an incremental cost-effectiveness ratio of $143,769 per QALY gained compared with vasectomy.
• Analysis revealed that salpingectomy was associated with 1215 fewer unintended pregnancies, 6085 fewer cases of ovarian cancer, and 4921 fewer ovarian cancer deaths annually than vasectomy.
• Individual-level QALYs showed minimal difference between strategies (45.6 for salpingectomy compared with 45.5 for vasectomy).
• For a population of 800,000, salpingectomy was associated with $7.1 billion in increased costs to the health system but resulted in 49,304 QALYs gained.

IN PRACTICE:

“Salpingectomy is not cost-effective compared with vasectomy at a WTP [willingness to pay] threshold of $100,000, despite lower unintended pregnancy rates and societal ovarian cancer burden. Shared decision-making, including a discussion of the long-term health benefits of salpingectomy, is important for couples deciding on permanent contraception procedures,” the authors of the study wrote.

SOURCE:

The study was led by Amy Pearson and Jill Brown, MD, MPH, from the School of Medicine and Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, Maryland. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

According to the authors, the model does not account for variations in ovarian cancer care costs and survival based on factors such as disease stage, age, race, and geographic region. The use of QALYs to characterize reproductive health outcomes requires methodologic refinement. Additionally, the analysis applies only to heterosexual couples seeking permanent contraception and would not apply to individuals with other circumstances.

DISCLOSURES:

The authors reported having no potential conflicts of interest. The opinions and assertions expressed do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Navy, or the Department of Defense.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.