Standalone salpingectomy for primary ovarian cancer prevention: a cost-effectiveness analysis

Opportunistic salpingectomy, salpingectomy performed at the time of other pelvic or abdominal surgery, is a cost-effective primary prevention strategy against ovarian cancer; however, the cost-effectiveness of standalone salpingectomy, performed independent of any other indicated surgery, is unknown.

We evaluated whether standalone salpingectomy is cost-effective in preventing ovarian cancer.

A state-transition Markov model was developed to simulate health and economic outcomes in patients ages 35, 40, 45, 50, and 60. Standalone salpingectomy was compared with no salpingectomy in simulated cohorts of individuals at population average risk and higher relative risks for ovarian cancer. Cost-effectiveness was assessed using incremental cost-effectiveness ratios and from a societal perspective to identify the relative risk at which standalone salpingectomy becomes a cost effective primary prevention strategy for ovarian cancer.

For general population risk, standalone salpingectomy was not cost-effective in any age cohort, with incremental cost-effectiveness ratios ranging from $239,736/quality-adjusted life-years (age 50) to $288,870/quality-adjusted life-years (age 35) against a $150,000/quality-adjusted life-years willingness-to-pay threshold. Incremental costs were approximately $6100-$6225 per person with gains of 0.02 to 0.03 quality-adjusted life-years. At a moderately increased risk (relative risk 1.5), incremental cost-effectiveness ratios fell to $142,516-$172,112/quality-adjusted life-years, making salpingectomy cost-effective at ages 45 and 50. At a relative risk of 2.0, it was cost-effective at all ages (incremental cost-effectiveness ratios $97,336-$118,544/quality-adjusted life-years). Relative risks for ovarian cancer at which standalone salpingectomy becomes cost-effective in each age group ranges from ≥1.44 to ≥1.67.

Standalone salpingectomy is a cost-effective strategy for the primary prevention of ovarian cancer in individuals with a moderately elevated risk of developing ovarian cancer but not in those with average population level risk. Further, standalone salpingectomy was cost effective for women ages 45 to 50 in the majority of simulations. At relative risks between 1.44 and 1.67, standalone salpingectomy was cost effective in each age cohort simulated, implying that there is a role for standalone salpingectomy when considering risk-stratified approaches to mitigating ovarian cancer risk.