Opportunistic Salpingectomy at Time of Nongynecologic Elective Procedures Could Reduce Ovarian Cancer–Related Costs and Mortality

Abstract

Objective: The primary aim of this research was to determine the cost-effectiveness of opportunistic salpingectomy (OpS) and oophorectomy during nongynecologic laparoscopic procedures and their effects on ovarian-cancer mortality. Materials and Methods: A recursive Markov model was constructed, including age-adjusted rates for appendectomy, cholecystectomy, hernia repair, and colon resection. The effects of OpS on women age >40 and bilateral salpingo-oophorectomy (BSO) in those age >50 were analyzed. The model was used to calculate life expectancy, overall health care costs, and costs of caring for patients with ovarian cancer. Results: OpS during elective nongynecologic surgeries reduces ovarian cancer deaths by 6.7%. BSO in patients older than 50 reduces mortality by 10.0%. OpS during hysterectomy or bilateral tubal ligation (BTL) reduces ovarian cancer mortality by 20.5%. In the United States, OpS with BSO during cholecystectomy prevents the most deaths at 973, compared to OpS alone during colon-cancer surgery, which prevents only 91 deaths per year. Considering the costs of the procedures, the incremental cost-effectiveness ratio for OpS and BSO at elective procedures is $6,567 (range: $3,874–$9,605). Considering the cost of caring for women with ovarian cancer, OpS and BSO produces cost savings with a 3% discount rate. New drug approvals for maintenance therapy could increase the cost savings as high as $296 per capita translating into a health care cost saving of $626 million per year in the United States. Conclusions: This model predicts that universal OpS and BSO during hysterectomy, BTL, and elective surgery will reduce ovarian cancer mortality and overall health expenditures. (J GYNECOL SURG 38:43)

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