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abstract/full text
OBJECTIVE: To conduct a cost-effectiveness analysis of
opportunistic salpingectomy (elective salpingectomy at hysterectomy or
instead of tubal ligation).
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
Over the past decade, there is increasing evidence that the majority of
ovarian cancers arise in the fallopian tube and not primarily in the
ovary.1–4
Consequently, in 2010 the British Columbia Ovarian Cancer Research
Group
launched an educational campaign about the potential benefit of “opportunistic salpingectomy” done concurrently with hysterectomy for benign gynecologic conditions or instead of tubal ligation for contraception. It was estimated that this practice could reduce ovarian cancer risk by 20–40% over the next 20 years.5.....
launched an educational campaign about the potential benefit of “opportunistic salpingectomy” done concurrently with hysterectomy for benign gynecologic conditions or instead of tubal ligation for contraception. It was estimated that this practice could reduce ovarian cancer risk by 20–40% over the next 20 years.5.....
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