Opportunistic Salpingectomy at the Time of Laparoscopic Cholecystectomy for Ovarian Cancer Prevention: A Cost-Effectiveness Analysis.

OBJECTIVE: To perform a cost-effectiveness analysis to examine the utility and effectiveness of opportunistic salpingectomy (OS) performed at the time of elective cholecystectomy (LAP-CHOL).

SUMMARY BACKGROUND DATA: OS has been adopted as a strategy to reduce the risk of ovarian cancer in women undergoing hysterectomy and tubal sterilization, although the procedure is rarely performed as a risk reducing strategy during other abdominopelvic procedures.

METHODS: A decision model was created to examine women 40, 50, and 60 years of age undergoing LAP-CHOL with or without OS. The lifetime risk of ovarian cancer was assumed to be 1.17%, 1.09%, and 0.92% for women age 40, 50, and 60 years, respectively. OS was estimated to provide a 65% reduction in the risk of ovarian cancer and to require 30 additional minutes of operative time. We estimated the cost, quality-adjusted life-years, ovarian cancer cases and deaths prevented with OS.

RESULTS: The additional cost of OS at LAP-CHOL ranged from $1,898-1,978. In a cohort of 5,000 women, OS reduced the number of ovarian cancer cases by 39, 36, and 30 cases and deaths by 12, 14, and 16 in the age 40-, 50-, and 60-year-old cohorts, respectively. OS during LAP-CHOL was cost-effective, with ICERs of $11,162-26,463 in the three age models. In a probabilistic sensitivity analysis, ICERs for OS were less than $100,000 per QALY in 90.5% or more of 1,000 simulations.

CONCLUSIONS: and Relevance: OS at the time of LAP-CHOL may be a cost-effective strategy to prevent ovarian cancer among average risk women.