Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery

Venkatesh, Kartik K.; Clark, Leslie H.; Stamilio, David M.

doi:10.1016/j.ajog.2018.08.032

Cited by 26 publications

(20 citation statements)

References 61 publications

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“…Six studies [ 34 , 35 , 46 , 49 , 50 , 51 ] included women who opted for permanent sterilisation; two [ 49 , 51 ] of them assessed permanent sterilisation in the context of a caesarean section. In the four (non-caesarean section) studies, only Dilley et al [ 34 ] incorporated a disutility of 0.77 for surgical complication over one year.…”

Section: Resultsmentioning

confidence: 99%

“…In the two studies evaluating the cost-effectiveness of OBS in the context of caesarean, they both found that OBS was cost-effective, with an ICUR of $28,109/QALY [ 49 ] and $24,490/QALY [ 51 ] compared to tubal ligation. OBS for permanent sterilisation during caesarean section could prevent one OC case in every 261/589 women, one OC-death in every 437/770 women and one unintended pregnancy in every 400/1134 women compared with tubal ligation [ 49 , 51 ]. The two models did not consider disutility from OBS or tubal ligation.…”

Section: Resultsmentioning

confidence: 99%

“…Base case results were highly sensitive to OC risk reduction, procedure costs, complication rates and the failure rate in terms of OBS. OBS was no longer cost-effective if its cost was >$3341 more than that of tubal ligation or >$10,599, if the OC risk reduction regarding OBS was <41–52%, if the OC risk reduction regarding tubal ligation was >46%, if the complication rate regarding OBS was >9.9%, or if the failure rate regarding OBS was >50% [ 49 , 51 ]. PSA results demonstrated that OBS was cost-effective at the time of caesarean in roughly 50–70% of simulations [ 49 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review

Xia

Oxley

Sideris

et al. 2022

Cancers

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Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for BRCA1/2, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review

Xia

Oxley

Sideris

et al. 2022

Cancers

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“…In addition, PBS in women undergoing surgical sterilization (N=4, (31)(32)(33)(34)) was reported to be cost-effective with ICURs ranging from 7,000 to 18,000 Euros/QALY (ICER range: 4,000-12,000 Euros/LYG) compared to surgical sterilization alone.…”

Section: (A) Ovarian Cancer Screeningmentioning

confidence: 99%

A Systematic Review on Cost-effectiveness Studies Evaluating Ovarian Cancer Early Detection and Prevention Strategies

Sroczynski

Gogollari

Kuehne

et al. 2020

Cancer Prevention Research

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“…In 2015, an American College of Obstetricians and Gynecologists Committee Opinion recommended that obstetricians should discuss the possible risk-reducing benefits of bilateral salpingectomy with patients who wish to have permanent contraception ( 13 ) . However, the embracement of this strategy at the time of cesarean delivery for pregnant women who desire permanent sterilization has not been widely adopted, probably due to a lack of available data including the surgical and psychological data in this setting ( 14 ) . By 2017, the overall proportion of salpingectomies in patients who underwent a permanent contraception procedure was reported to be as high as 61.5%, in a nationwide data analysis ( 15 ) .…”

Section: Discussionmentioning

confidence: 99%

Patients’ perceptions toward and the driving factors of decision-making for opportunistic bilateral salpingectomy at the time of cesarean section

Yassa¹,

Pulatoğlu

2020

tjod

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Objective: Enough data can be found in the literature regarding the protective effect of tubal ligation on gynecological cancers. In addition, a large body of evidence revealed that prophylactic bilateral salpingectomy had no significant negative effect on the ovarian function, quality of life, sexuality, surgery duration, and cost-effectivity. This study was aimed at exploring the underlying factors that motivate women for either opportunistic bilateral salpingectomy (OBS) or tubal ligation, particularly focusing on their preferences, knowledge, and beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Materials and Methods: A total of 54 patients who had undergone surgical sterilization with either OBS or tubal ligation were included in this prospective cohort study. The acceptance rate of the OBS at the time of cesarean section among pregnant women seeking surgical sterilization was calculated. The underlying reasons for women’s acceptance or refusal for salpingectomy were assessed by a non-validated data collection tool that had 14 open-ended questions focusing on the women’s preferences, knowledge, beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Results: The acceptance rate of OBS at the time of cesarean section among pregnant women and electively among non-pregnant women were 93.5% (n=43/46) and 75% (6/8), respectively. The main driving factors influencing the decision of preferring OBS over tubal ligation were the risk-reducing effect for ovarian cancer and superior pregnancy prevention. Conclusion: The acceptance rate of OBS at the time of cesarean section was found to be very high, and it should therefore be offered at the time of cesarean section to women who desire permanent contraception.

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Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery

Cited by 26 publications

References 61 publications

Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review

Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review

A Systematic Review on Cost-effectiveness Studies Evaluating Ovarian Cancer Early Detection and Prevention Strategies

Patients’ perceptions toward and the driving factors of decision-making for opportunistic bilateral salpingectomy at the time of cesarean section

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