Use of Office Versus Ambulatory Surgery Center Setting and Associated Ancillary Services on Healthcare Cost Burden for Vasectomy Procedures.

OBJECTIVE: To analyze variation in total healthcare costs for vasectomies performed in the United States, based on procedure setting and use of ancillary pathology services.

METHODS: We queried the MarketScan Commercial Claims database using CPT, ICD, and HCPCS codes to identify men who underwent vasectomy between 2009-2015, either in the office or ambulatory surgical center (ASC) setting, with or without use of pathology services. All payments for each treatment episode were calculated based on relevant claims. Patient out-of-pocket expenses were defined as the sum of co-payments, co-insurance and deductibles for each claim. Trends in vasectomy use, and differences in procedure costs by practice setting were compared over the study period.

RESULTS: 453,492 men underwent a vasectomy between 2009-2015. The number of procedures decreased from 76,197 in 2009 to 37,575 in 2015 (p=0.002). Average procedural costs increased from $870 in 2009 to $938 in 2015 (p=0.001). Overall, 82.6% and 17.4% of procedures were performed in the office vs. ASCs, respectively. In-office procedures were associated with lower total healthcare costs ($707 vs. $1851) and lower patient out-of-pocket expenses ($173 vs. $356) than those performed in ASCs. Vasal segments were submitted for pathologic evaluation in 40% of cases, which increased average payments by 55%. The use of ASCs and ancillary pathology services for vasectomies performed during the study period increased vasectomy-associated costs by $64 million.

CONCLUSIONS: The unnecessary use of ASCs and ancillary pathology services for vasectomy may lead to tens of millions of dollars in potentially avoidable healthcare costs annually.