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Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.

Publication ,  Journal Article
Dilley, SE; Havrilesky, LJ; Bakkum-Gamez, J; Cohn, DE; Michael Straughn, J; Caughey, AB; Rodriguez, MI
Published in: Gynecol Oncol
August 2017

OBJECTIVES: Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. METHODS: We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. RESULTS: In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. CONCLUSIONS: Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

August 2017

Volume

146

Issue

2

Start / End Page

373 / 379

Location

United States

Related Subject Headings

  • Uterine Diseases
  • Sterilization, Tubal
  • Salpingectomy
  • SEER Program
  • Quality-Adjusted Life Years
  • Prophylactic Surgical Procedures
  • Postoperative Complications
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Monte Carlo Method
 

Citation

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Dilley, S. E., Havrilesky, L. J., Bakkum-Gamez, J., Cohn, D. E., Michael Straughn, J., Caughey, A. B., & Rodriguez, M. I. (2017). Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol, 146(2), 373–379. https://doi.org/10.1016/j.ygyno.2017.05.034
Dilley, Sarah E., Laura J. Havrilesky, Jamie Bakkum-Gamez, David E. Cohn, J. Michael Straughn, Aaron B. Caughey, and Maria I. Rodriguez. “Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.Gynecol Oncol 146, no. 2 (August 2017): 373–79. https://doi.org/10.1016/j.ygyno.2017.05.034.
Dilley SE, Havrilesky LJ, Bakkum-Gamez J, Cohn DE, Michael Straughn J, Caughey AB, et al. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol. 2017 Aug;146(2):373–9.
Dilley, Sarah E., et al. “Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.Gynecol Oncol, vol. 146, no. 2, Aug. 2017, pp. 373–79. Pubmed, doi:10.1016/j.ygyno.2017.05.034.
Dilley SE, Havrilesky LJ, Bakkum-Gamez J, Cohn DE, Michael Straughn J, Caughey AB, Rodriguez MI. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol. 2017 Aug;146(2):373–379.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

August 2017

Volume

146

Issue

2

Start / End Page

373 / 379

Location

United States

Related Subject Headings

  • Uterine Diseases
  • Sterilization, Tubal
  • Salpingectomy
  • SEER Program
  • Quality-Adjusted Life Years
  • Prophylactic Surgical Procedures
  • Postoperative Complications
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Monte Carlo Method