Kwon Janice S, McAlpine Jessica N, Hanley Gillian E, Finlayson Sarah J, Cohen Trevor, Miller Dianne M, Gilks C Blake, Huntsman David G
Division of Gynecologic Oncology, University of British Columbia and OVCARE, Vancouver, British Columbia, Canada.
Obstet Gynecol. 2015 Feb;125(2):338-345. doi: 10.1097/AOG.0000000000000630.
To conduct a cost-effectiveness analysis of opportunistic salpingectomy (elective salpingectomy at hysterectomy or instead of tubal ligation).
A Markov Monte Carlo simulation model estimated the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured in terms of life expectancy gain. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number of ovarian cancer cases associated with each strategy in the Canadian population.
Salpingectomy with hysterectomy was less costly ($11,044.32 ± $1.56) than hysterectomy alone ($11,206.52 ± $29.81) or with bilateral salpingo-oophorectomy ($12,626.84 ± $13.11) but more effective at 21.12 ± 0.02 years compared with 21.10 ± 0.03 and 20.94 ± 0.03 years, representing average gains of 1 week and 2 months, respectively. For surgical sterilization, salpingectomy was more costly ($9,719.52 ± $3.74) than tubal ligation ($9,339.48 ± $26.74) but more effective at 22.45 ± 0.02 years compared with 22.43 ± 0.02 years (average gain of 1 week) with an incremental cost-effectiveness ratio of $27,278 per year of life gained. Our results were stable over a wide range of costs and risk estimates. Monte Carlo simulation predicted that salpingectomy would reduce ovarian cancer risk by 38.1% (95% confidence interval [CI] 36.5-41.3%) and 29.2% (95% CI 28.0-31.4%) compared with hysterectomy alone or tubal ligation, respectively.
Salpingectomy with hysterectomy for benign conditions will reduce ovarian cancer risk at acceptable cost and is a cost-effective alternative to tubal ligation for sterilization. Opportunistic salpingectomy should be considered for all women undergoing these surgical procedures.
对机会性输卵管切除术（子宫切除术时选择性输卵管切除术或替代输卵管结扎术）进行成本效益分析。
采用马尔可夫蒙特卡洛模拟模型，估计在因良性妇科疾病接受子宫切除术或手术绝育的假设女性队列中，机会性输卵管切除术的成本和收益。主要结局指标为增量成本效益比。有效性以预期寿命增加来衡量。敏感性分析考虑了各种参数的不确定性。蒙特卡洛模拟估计了加拿大人群中与每种策略相关的卵巢癌病例数。
子宫切除术中同时行输卵管切除术的成本（11,044.32美元±1.56美元）低于单纯子宫切除术（11,206.52美元±29.81美元）或子宫切除术加双侧输卵管卵巢切除术（12,626.84美元±13.11美元），但预期寿命更有效，分别为21.12±0.02年，而单纯子宫切除术为21.10±0.03年，子宫切除术加双侧输卵管卵巢切除术为20.94±0.03年，分别平均增加1周和2个月。对于手术绝育，输卵管切除术的成本（9,719.52美元±3.74美元）高于输卵管结扎术（9,339.48美元±26.74美元），但预期寿命更有效，分别为22.45±0.02年和22.43±0.02年（平均增加1周），增量成本效益比为每增加一年预期寿命27,278美元。我们的结果在广泛的成本和风险估计范围内是稳定的。蒙特卡洛模拟预测，与单纯子宫切除术或输卵管结扎术相比，输卵管切除术将分别降低38.1%（95%置信区间[CI]36.5 - 41.3%）和29.2%（95%CI 28.0 - 31.4%）的卵巢癌风险。
因良性疾病行子宫切除术时同时行输卵管切除术将以可接受的成本降低卵巢癌风险，是输卵管结扎术绝育的一种具有成本效益的替代方法。对于所有接受这些手术的女性，应考虑机会性输卵管切除术。
