Opportunistic salpingectomy at the time of benign gynecologic surgery and cesarean delivery is a cost-effective strategy for ovarian cancer risk reduction. We sought to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation in the immediate postpartum period following vaginal deliveries.
Using two decision analytic models, we simulated a hypothetical cohort of 10,000 women undergoing bilateral salpingectomy or tubal ligation immediately following vaginal delivery. We derived probabilities of ovarian cancer risk reduction following tubal sterilization from published literature. We used institutional charge data to determine cost inputs. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Institutional review board (IRB) approval was obtained.
Opportunistic salpingectomy is more cost-effective than tubal ligation following vaginal delivery in a theoretical cohort, with an ICER of $24,176/QALY. Compared to tubal ligation, opportunistic salpingectomy yields a theoretical total cost savings of $6.48 million. Discounted costs of ovarian cancer were $2.9 million lower for the salpingectomy cohort compared to tubal ligation. Opportunistic salpingectomy avoided 12 fewer ovarian cancer cases and 8 fewer ovarian cancer deaths compared to tubal ligation.
Our analytic model demonstrates that following vaginal delivery, opportunistic salpingectomy is a cost-effective strategy for reducing risk of ovarian cancer. Compared to tubal ligation, opportunistic salpingectomy reduces ovarian cancer cases and mortality.