Cost-Effectiveness of Opportunistic Salpingectomy During Various Nongynecological Abdominal Surgeries for the Prevention of Tubo-Ovarian Carcinoma: Results From a Markov Modeling Study.

Abstract

Objectives: Opportunistic salpingectomy (OS), the additional removal of the fallopian tubes during abdominal surgery, is a preventive strategy against tubo-ovarian carcinoma. Little is known about the economic impact of OS during nongynecological surgeries.

Methods: Markov state transition models were created comparing the addition of OS in women aged 35 to 65 during cholecystectomy, bariatric surgery, nephrectomy for renal cell carcinoma, and colectomy for colorectal cancer to no addition of OS. Quality-adjusted life-years (QALYs) and healthcare costs were modeled over a lifetime horizon, and uncertainty was assessed with sensitivity analyses. A willingness-to-pay threshold of €20 000 was applied.

Results: OS during cholecystectomy and bariatric surgery resulted in a QALY gain of 0.033 and 0.034, and a cost reduction of €12 and €7 per patient, respectively. The probability that OS is cost-effective exceeded 99%. OS during nephrectomy for renal cell carcinoma or colectomy for colorectal cancer yielded a QALY gain of 0.012 and 0.016 and a cost increase of €39 and €25 per patient, respectively. The probability that OS is cost-effective was 94.2% and 96.6%.

Conclusion: Modeling OS during nongynecological surgeries for benign indications suggests that the procedure may be cost-effective, resulting in QALY gain and potential cost savings. For oncologic indications OS appears to be cost-effective, yielding a gain in QALYs, while also leading to an increase in costs. However, the results should be considered exploratory and interpreted with caution in light of the model assumptions.