638: The cost-effectiveness of salpingectomy versus standard tubal ligation at the time of cesarean delivery

Abstract

Salpingectomy (SPG) is a cost-effective strategy recommended for ovarian cancer (OVCA) risk reduction (RR) at the time of gynecologic surgery in women who have completed childbearing. We have shown that SPG in lieu of standard tubal ligation (TL) during cesarean delivery (CD) is feasible and safe. We evaluated the cost-effectiveness of SPG compared to TL during CD as an OVCA RR strategy. We performed a cost-effectiveness analysis using results from the SCORE trial, an RCT (NCT02374827) of SPG versus TL in women desiring permanent sterilization at CD. We constructed a decision model to compare the effectiveness and cost of SPG and TL at the time of CD using probabilities of procedure completion derived from the primary trial (SPG group: 67.5% SPG, 27.5% converted to TL). As procedural complications were similar between groups in the trial, they were not considered in the model. Procedure costs were based on 2017 CMS Physician Fees and ICD-10 billing data; costs and probabilities related to OVCA were derived from the literature. Both utilities and costs were discounted. The primary outcome was the incremental cost-effectiveness ratio (ICER). We assigned a cost-effectiveness willingness-to-pay (WTP) threshold of $100,000/QALY. One-way and two-way sensitivity analyses were performed for all variables. In the base-case analysis, SPG was cost-effective compared to TL with an ICER of $48,360/QALY (Table). In a hypothetical cohort of 10,000 women desiring permanent sterilization with CD, a strategy using SPG as opposed to TL would result in 19 fewer OVCA diagnoses, and 10 fewer OVCA deaths at an additional cost of $6,291,290 (Table). The model was sensitive to only 3 variables: SPG cost, OVCA RR from SPG, and the OVCA RR of TL. SPG was not cost effective if SPG cost was >$4,821, if the RR of SPG was <41%, or if the RR of TL was >39%. Moreover, SPG was cost-saving compared to TL if the cost of SPG was <$2,893 (<$303 more than TL). Two-way sensitivity analyses revealed that SPG is often the most cost-effective strategy - even at a success rate as low as 50%. (Figure). In women undergoing CD with permanent sterilization, SPG is cost-effective in comparison to standard TL for OVCA RR. As it feasible and safe, it should be considered as a primary method for surgical sterilization during CD in women with undesired fertility.View Large Image Figure ViewerDownload Hi-res image Download (PPT)