Wagar Matthew K, Forlines Grayson L, Moellman Nicholas, Carlson Anisa, Matthews Michael, Williams Makeba
Division of Gynecologic Oncology and the Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; the Department of Health Care Financing & Payment, Research Triangle Institute, Research Triangle Park, North Carolina; the Department of Accounting, Finance and Economics, Winthrop University, Rock Hill, South Carolina; and the Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Obstet Gynecol. 2023 Apr 1;141(4):819-827. doi: 10.1097/AOG.0000000000005118. Epub 2023 Mar 9.
To compare the cost effectiveness of opportunistic salpingectomy and bilateral tubal ligation for sterilization immediately after vaginal delivery.
A cost-effectiveness analytic decision model was used to compare opportunistic salpingectomy with bilateral tubal ligation during vaginal delivery admission. Probability and cost inputs were derived from local data and available literature. Salpingectomy was assumed to be performed with a handheld bipolar energy device. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2019 U.S. dollars per quality-adjusted life-year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to determine the proportion of simulations in which salpingectomy would be cost effective.
Opportunistic salpingectomy was more cost effective than bilateral tubal ligation with an ICER of $26,150/QALY. In 10,000 patients desiring sterilization after vaginal delivery, opportunistic salpingectomy would result in 25 fewer ovarian cancer cases, 19 fewer ovarian cancer deaths, and 116 fewer unintended pregnancies than bilateral tubal ligation. In sensitivity analysis, salpingectomy was cost effective in 89.8% of simulations and cost saving in 13% of simulations.
In patients undergoing sterilization immediately after vaginal deliveries, opportunistic salpingectomy is more cost effective and may be more cost saving than bilateral tubal ligation for reducing ovarian cancer risk.
比较阴道分娩后立即进行机会性输卵管切除术和双侧输卵管结扎绝育术的成本效益。
采用成本效益分析决策模型，比较阴道分娩入院期间机会性输卵管切除术与双侧输卵管结扎术。概率和成本数据来自当地资料及现有文献。假设输卵管切除术使用手持双极能量设备进行。主要结局是增量成本效益比（ICER），以2019年美元计，每质量调整生命年（QALY）的成本效益阈值为100,000美元/QALY。进行敏感性分析以确定输卵管切除术具有成本效益的模拟比例。
机会性输卵管切除术比双侧输卵管结扎术更具成本效益，ICER为26,150美元/QALY。在10,000例阴道分娩后希望绝育的患者中，与双侧输卵管结扎术相比，机会性输卵管切除术将使卵巢癌病例减少25例，卵巢癌死亡减少19例，意外妊娠减少116例。在敏感性分析中，输卵管切除术在89.8%的模拟中具有成本效益，在13%的模拟中节省成本。
对于阴道分娩后立即进行绝育的患者，机会性输卵管切除术在降低卵巢癌风险方面比双侧输卵管结扎术更具成本效益，且可能更节省成本。
