University of Alabama at Birmingham, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, United States of America.
University of Utah, Division of Maternal-Fetal Medicine, Salt Lake City, UT, United States of America.
Gynecol Oncol. 2019 Jan;152(1):127-132. doi: 10.1016/j.ygyno.2018.11.009. Epub 2018 Nov 23.
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.
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.
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 >$3163.74 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.
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.
在已完成生育的女性接受妇科手术时，机会性输卵管切除术是一种具有成本效益的策略，推荐用于降低卵巢癌（OvCa）风险。我们旨在评估与剖宫产时标准输卵管结扎术（TL）相比，机会性输卵管切除术的成本效益。
使用决策模型进行成本效益分析，比较在剖宫产时行机会性输卵管切除术与 TL 的情况，使用来自试验的程序完成概率。概率和成本输入来自当地数据和文献。主要结果是在 2017 年以美元计算的每质量调整生命年（QALY）增量成本效益比（ICER），成本效益阈值为 10 万美元/QALY。对所有变量进行了单因素和双因素敏感性分析。概率敏感性分析确定了每种策略具有成本效益的模拟比例。
与 TL 相比，机会性输卵管切除术具有成本效益，ICER 为每 QALY 26616 美元。在 10000 名希望通过剖宫产进行绝育的女性中，与 TL 相比，机会性输卵管切除术将导致 OvCa 诊断减少 17 例，OvCa 死亡减少 13 例，意外妊娠减少 25 例 - 相关成本增加 4700 万美元。该模型仅对输卵管切除术和 TL 的 OvCa 风险降低敏感。如果机会性输卵管切除术的成本比 TL 高出 >3163.74 美元，如果输卵管切除术的风险降低 <41%，或者 TL 的风险降低 >46%，则机会性输卵管切除术没有成本效益。在概率敏感性分析中，75%的模拟中机会性输卵管切除术具有成本效益。
在接受剖宫产并进行绝育的女性中，与 TL 相比，机会性输卵管切除术可能具有成本效益，并且可能会降低 OvCa 风险，从而节省成本。
