The impact of opportunistic salpingectomy on ovarian cancer mortality and healthcare costs: a call for universal insurance coverage

Naumann, R. Wendel; Hughes, Brittany N.; Brown, Jubilee; Drury, Lane; Herzog, Thomas J.

doi:10.1016/j.ajog.2021.03.032

Cited by 18 publications

(19 citation statements)

References 22 publications

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“…Four studies evaluated the cost-effectiveness of OBS in women undergoing hysterectomy for benign gynaecologic conditions. OBS conducted along with hysterectomy (vaginal, laparoscopic or not specified) was found to be cost-effective, with an ICUR of $1667/QALY [ 46 ], or cost-saving [ 34 , 35 , 42 ] for OC prevention compared with hysterectomy alone. Switching from hysterectomy alone to hysterectomy with OBS could prevent one OC case in every 189/225/273 women and prevent one OC death in every 358/450 women [ 34 , 35 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…This highlights the need for prospective high-quality data to improve the precision of OC risk-reduction from OBS and establish its cost-effectiveness. OBS also appeared to be cost-effective as a result of sensitivity analysis if the complication rate rose up to 17.8%, if it costed up to $13,540 or the inadvertent oophorectomy risk during OBS was lower than 2% [ 34 , 35 , 46 ]. OBS was also found to be cost-saving compared with BSO with hysterectomy in pre-menopausal women, and if the age at hysterectomy exceeded 50.87 years, hysterectomy with BSO would become the dominant strategy [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 four (non-caesarean section) studies, only Dilley et al [ 34 ] incorporated a disutility of 0.77 for surgical complication over one year. OBS was reported to be cost-saving [ 50 ] or cost-effective, with an ICER/ICUR ranging from $5469 to $33,883 per LYG or QALY [ 34 , 35 , 46 ], compared with other surgical sterilisation techniques including tubal ligation, clips or coagulation for reducing the risk of OC. Routine OBS at the time of permanent sterilisation could prevent one OC case in every 150/366/435 women, one OC death in every 834 women and one unintended pregnancy in every 1429 women compared with traditional surgical sterilisations [ 34 , 35 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, OBS was still cost-effective, with an OC risk reduction from OBS higher than 54% or at least a 25% increased reduction in OC risk compared to tubal sterilisation. Sensitivity analysis indicated that OBS would remain cost-effective for a complication rate of up to 2.5%, with cost below $7265 or less than that of tubal ligation by at least $1094, or with a pregnancy rate after OBS lower than 2.9% [ 34 , 35 , 46 ]. Specifically, one study found that OBS was no longer cost-effective compared to tubal coagulation if conducted at the age of 45 instead of 40 [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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Salpingectomy in Ovarian Cancer Prevention

Stone

Sakran

Roche

2023

JAMA

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Salpingectomy and the Risk of Ovarian Cancer in Ontario

et al. 2023

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ImportanceA body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian cancers. Consequently, salpingectomy is now considered for permanent contraception (in lieu of tubal ligation) or ovarian cancer prevention (performed opportunistically at the time of surgical procedures for benign gynecologic conditions).ObjectiveTo evaluate the association between salpingectomy and the risk of invasive epithelial ovarian, fallopian tube, and peritoneal cancer.Design, Setting, and ParticipantsThis population-based retrospective cohort study included all women aged 18 to 80 years who were eligible for health care services in Ontario, Canada. Participants were identified using administrative health databases from Ontario between January 1, 1992, and December 31, 2019. A total of 131 516 women were included in the primary (matched) analysis. Women were followed up until December 31, 2021.ExposuresSalpingectomy (with and without hysterectomy) vs no pelvic procedure (control condition) among women in the general population.Main Outcomes and MeasuresWomen with a unilateral or bilateral salpingectomy in Ontario between April 1, 1992, and December 31, 2019, were matched 1:3 to women with no pelvic procedure from the general population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for ovarian, fallopian tube, and peritoneal cancer combined.ResultsAmong 131 516 women (mean [SD] age, 42.2 [7.6] years), 32 879 underwent a unilateral or bilateral salpingectomy, and 98 637 did not undergo a pelvic procedure. After a mean (range) follow-up of 7.4 (0-29.2) years in the salpingectomy group and 7.5 (0-29.2) years in the nonsurgical control group, there were 31 incident cancers (0.09%) and 117 incident cancers (0.12%), respectively (HR, 0.82; 95% CI, 0.55-1.21). The HR for cancer incidence was 0.87 (95% CI, 0.53-1.44) when comparing those with salpingectomy vs those with hysterectomy alone.Conclusions and RelevanceIn this cohort study, no association was found between salpingectomy and the risk of ovarian cancer; however, this observation was based on few incident cases and a relatively short follow-up time. Studies with additional years of follow-up are necessary to define the true level of potential risk reduction with salpingectomy, although longer follow-up will also be a challenge unless collaborative efforts that pool data are undertaken.

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The impact of opportunistic salpingectomy on ovarian cancer mortality and healthcare costs: a call for universal insurance coverage

Cited by 18 publications

References 22 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

Salpingectomy in Ovarian Cancer Prevention

Salpingectomy and the Risk of Ovarian Cancer in Ontario

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