Costs and Benefits of Opportunistic Salpingectomy as an Ovarian Cancer Prevention Strategy

OBJECTIVE: To conduct a cost-effectiveness analysis of opportunistic salpingectomy (elective salpingectomy at hysterectomy or instead of tubal ligation). METHODS: A Markov Monte Carlo simulation model estimated the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured in terms of life expectancy gain. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number of ovarian cancer cases associated with each strategy in the Canadian population. RESULTS: Salpingectomy with hysterectomy was less costly ($11,044.32 +/-$1.56) than hysterectomy alone ($11,206.52 +/-$29.81) or with bilateral salpingo-oophorectomy ($12,626.84 +/-$13.11) but more effective at 21.12 +/- 0.02 years compared with 21.10 +/- 0.03 and 20.94 +/- 0.03 years, representing average gains of 1 week and 2 months, respectively. For surgical sterilization, salpingectomy was more costly ($9,719.52 +/-$3.74) than tubal ligation ($9,339.48 +/-$26.74) but more effective at 22.45 +/- 0.02 years compared with 22.43 +/- 0.02 years (average gain of 1 week) with an incremental cost-effectiveness ratio of $27,278 per year of life gained. Our results were stable over a wide range of costs and risk estimates. Monte Carlo simulation predicted that salpingectomy would reduce ovarian cancer risk by 38.1% (95% confidence interval [CI] 36.5-41.3%) and 29.2% (95% CI 28.0-31.4%) compared with hysterectomy alone or tubal ligation, respectively. CONCLUSION: Salpingectomy with hysterectomy for benign conditions will reduce ovarian cancer risk at acceptable cost and is a cost-effective alternative to tubal ligation for sterilization. Opportunistic salpingectomy should be considered for all women undergoing these surgical procedures.