Cost-effectiveness of opportunistic salpingectomy during various non-gynecological abdominal surgeries for the prevention of tubo-ovarian carcinoma: results from a Markov Modelling study.

BACKGROUND: Opportunistic salpingectomy (OS), the additional removal of the fallopian tubes during abdominal surgery, is a preventive strategy against tubo-ovarian carcinoma. Little is known about the economic impact of OS during non-gynecological surgeries. METHODS: Markov state transition models were created comparing the addition of OS in women aged 35-65 during cholecystectomy, bariatric surgery, nephrectomy for renal cell carcinoma (RCC), and colectomy for colorectal cancer (CRC) to no addition of OS. Quality-adjusted life-years (QALYs) and healthcare costs were modelled over a lifetime horizon and uncertainty was assessed with sensitivity analyses. A willingness-to-pay threshold of €20,000 was applied. RESULTS: OS during cholecystectomy and bariatric surgery resulted in a QALY gain of 0.033 and 0.034, and a cost reduction of €12 and €7 per patient, respectively. The probability that OS is cost-effective exceeded 99%. OS during nephrectomy for RCC or colectomy for CRC yielded a QALY gain of 0.012 and 0.016, and a cost increase of €39 and €25 per patient, respectively. The probability that OS is cost-effective was 94.2% and 96.6%. CONCLUSION: Modelling OS during non-gynecological surgeries for benign indications suggests that the procedure may be cost-effective, resulting in QALY gain and potential cost-savings. For oncologic indications OS appears to be cost-effective, yielding a gain in QALYs, while also leading to an increase in costs. However, the results should be considered exploratory and interpreted with caution in light of the model assumptions.