Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception
OBJECTIVE:
To evaluate the cost effectiveness of salpingectomy compared with vasectomy for couples seeking permanent contraception.
METHODS:
We developed a decision tree model that used TreeAge to evaluate the cost effectiveness of vasectomy compared with salpingectomy for a hypothetical cohort of 800,000 people, the number of male and female patients who undergo permanent contraception procedures in the United States annually. Effectiveness was expressed in quality-adjusted life-years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY gained or lost. We derived costs, probabilities, and utilities from the literature, and estimated the incremental cost-effectiveness ratio (ICER) between the two strategies. We completed a probabilistic sensitivity analysis with 10,000 simulations and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. Secondary outcomes included the number of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths.
RESULTS:
Salpingectomy was not a cost-effective strategy, with an ICER of $143,769 per QALY gained compared with vasectomy. Probabilistic sensitivity analysis showed that the chance of vasectomy being cost effective was 81.5% but decreased to 14.7% with a WTP threshold of $200,000. Annually, salpingectomy was associated with 1,215 fewer unintended pregnancies, 6,085 fewer ovarian cancer cases, and 4,921 fewer ovarian cancer deaths compared with vasectomy.
CONCLUSION:
Salpingectomy is not cost effective compared with vasectomy at a WTP threshold of $100,000, despite lower unintended pregnancy rates and societal ovarian cancer burden. Shared decision making, including a discussion of the long-term health benefits of salpingectomy, is important for couples deciding on permanent contraception procedures.