Cost-Effectiveness of Salpingectomy vs. Vasectomy for Permanent Contraception

Amy Pearson1; Katerina Shvartsman2; Wu Zeng3; Jill Brown2

1. School of Medicine, Uniformed Services University, Bethesda, MD, USA

2. Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD, USA

3. Department of Global Health, School of Health, Georgetown University, Washington, D.C., USA

Abstract Text: Both salpingectomy and vasectomy are safe and effective methods of permanent contraception. Vasectomy is less invasive with lower procedural costs, while salpingectomy carries the additional benefit of reducing the risk of ovarian cancer. Our goal was to examine the cost-effectiveness of vasectomy compared to salpingectomy for couples seeking permanent contraception. We developed a decision tree model using TreeAge to evaluate the cost effectiveness of vasectomy compared to salpingectomy for a hypothetical cohort of 800,000 people, the annual number of male and female permanent contraception procedures in the United States. 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 ratios (ICER) between the two strategies. We completed a probabilistic sensitivity analysis (PSA) with 10,000 simulations and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. Secondary outcomes included numbers of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths. Salpingectomy was the less cost-effective strategy, with an ICER of $183,630 per QALY gained compared to vasectomy. PSA revealed the chance of vasectomy being more cost-effective was 90.9% but decreased to 38.7% with a WTP of $200,000. Annually, salpingectomy was associated with 1200 fewer unintended pregnancies, 6088 fewer ovarian cancer cases, and 4923 fewer ovarian cancer deaths compared to vasectomy. Salpingectomy is not cost effective compared to vasectomy using 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. The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Navy, or the Department of Defense. The authors have no conflicts of interest.