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Cost-Effectiveness of Opportunistic Salpingectomy at the Time of Laparoscopic Cholecystectomy for Ovarian Cancer Prevention
Findings from a recent cost-effective analysis revealed that opportunistic salpingectomy at the time of elective cholecystectomy (LAP-CHOL) may be a cost-effective strategy to prevent ovarian cancer among average risk women (Ann Surg. 2022. doi:10.1097/SLA.0000000000005374).
While opportunistic salpingectomy has been used to reduce the risk of ovarian cancer in women undergoing hysterectomy and tubal sterilization, it is rarely as a risk reducing strategy during other abdominopelvic procedures.
In this cost-effectiveness analysis, Koji Matsuo, MD, PhD, University of Southern California Columbia University College of Physicians and Surgeons University of Freiburg Faculty of Medicine Joseph L. Mailman School of Public Health, Columbia University, and colleagues examined the utility and effectiveness of opportunistic salpingectomy performed at the time of LAP-CHOL. Costs, quality-adjusted life-years, ovarian cancer cases and deaths prevented were assessed.
Dr Matsuo and colleagues created a decision model to examine women 40, 50, and 60 years of age undergoing LAP-CHOL with or without opportunistic salpingectomy. The lifetime risk of ovarian cancer was assumed to be 1.17% in patients age 40 years, 1.09% in patients age 50 years, and 0.92% in patients age 60 years.
Authors estimated that opportunistic salpingectomy would reduce the risk of ovarian cancer by 65% and require 30 additional minutes of operative time.
Opportunistic salpingectomy at LAP-CHOL resulted in an additional cost that ranged from $1898 to $1978. In patients age 40 years, opportunistic salpingectomy reduced the number of ovarian cancer cases by 39 and deaths by 12. In those age 50 years, opportunistic salpingectomy reduced the number of ovarian cancer cases by 36 and deaths by 14. In those age 60 years, it reduced the number of ovarian cancer cases by 30 and deaths by 16.
Three age models revealed that opportunistic salpingectomy during LAP-CHOL resulted in ICERs of $11,162 to $26,463, suggesting that it’s a cost-effective strategy.
A probabilistic sensitivity analysis revealed that ICERs for opportunistic salpingectomy were less than $100,000 per QALY in 90.5% or more of 1000 simulations.
“OS [opportunistic salpingectomy] at the time of LAP-CHOL may be a cost-effective strategy to prevent ovarian cancer among average risk women,” concluded Dr Matsuo and colleagues.
