Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception

Area of Science:

• Reproductive Health
• Health Economics
• Gynecologic Oncology

Background:

• Permanent contraception is a common choice for couples.
• Vasectomy and salpingectomy are primary methods for permanent contraception.
• Evaluating the economic value of these procedures is essential for healthcare planning.

Purpose of the Study:

• To compare the cost-effectiveness of salpingectomy versus vasectomy for permanent contraception.
• To analyze secondary outcomes including unintended pregnancies and ovarian cancer incidence.

Main Methods:

• A decision tree model evaluated 800,000 individuals undergoing permanent contraception annually in the US.
• Effectiveness was measured in quality-adjusted life-years (QALYs) with a willingness-to-pay (WTP) threshold of $100,000 per QALY.
• Probabilistic sensitivity analysis and cost-effectiveness acceptability curves were generated.

Main Results:

• Salpingectomy had an incremental cost-effectiveness ratio (ICER) of $143,769 per QALY gained compared to vasectomy.
• Vasectomy had an 81.5% probability of being cost-effective at a $200,000 WTP threshold.
• Salpingectomy was associated with fewer unintended pregnancies and ovarian cancer cases/deaths annually.

Conclusions:

• Salpingectomy is not cost-effective compared to vasectomy at a $100,000 WTP threshold.
• Despite not being cost-effective, salpingectomy offers significant reductions in unintended pregnancies and ovarian cancer burden.
• Shared decision-making is vital, incorporating discussions on long-term health benefits for couples choosing permanent contraception.