Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception.

Abstract

OBJECTIVE To evaluate the cost effectiveness of salpingectomy compared with vasectomy for couples seeking permanent contraception. METHODS We developed a decision tree model that used TreeAge to evaluate the cost effectiveness of vasectomy compared with salpingectomy for a hypothetical cohort of 800,000 people, the number of male and female patients who undergo permanent contraception procedures in the United States annually. Effectiveness was expressed in quality-adjusted life-years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY gained or lost. We derived costs, probabilities, and utilities from the literature, and estimated the incremental cost-effectiveness ratio (ICER) between the two strategies. We completed a probabilistic sensitivity analysis with 10,000 simulations and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. Secondary outcomes included the number of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths. RESULTS Salpingectomy was not a cost-effective strategy, with an ICER of $143,769 per QALY gained compared with vasectomy. Probabilistic sensitivity analysis showed that the chance of vasectomy being cost effective was 81.5% but decreased to 14.7% with a WTP threshold of $200,000. Annually, salpingectomy was associated with 1,215 fewer unintended pregnancies, 6,085 fewer ovarian cancer cases, and 4,921 fewer ovarian cancer deaths compared with vasectomy. CONCLUSION Salpingectomy is not cost effective compared with vasectomy at a WTP threshold of $100,000, despite lower unintended pregnancy rates and societal ovarian cancer burden. Shared decision making, including a discussion of the long-term health benefits of salpingectomy, is important for couples deciding on permanent contraception procedures.