abstract
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.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.