title: Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).
abstract: OBJECTIVE
  Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube?
  
  
  CONCLUSIONS
  Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher.
  
  
  BACKGROUND
  Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy.
  
  
  METHODS
  We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively.
  
  
  METHODS
  We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle.
  
  
  RESULTS
  Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by natural conception compared with salpingectomy leading to an incremental cost-effectiveness ratio €40 982 (95% confidence interval -€130 319 to €145 491) per ongoing pregnancy. Since salpingotomy resulted in more additional treatments for persistent trophoblast and interventions for repeat ectopic pregnancy, the incremental cost-effectiveness ratio was not informative.
  
  
  CONCLUSIONS
  Costs of any subsequent IVF cycles were not included in this analysis. The analysis was limited to the perspective of the hospital.
  
  
  CONCLUSIONS
  However, a small treatment benefit of salpingotomy might be enough to cover the costs of subsequent IVF. This uncertainty should be incorporated in shared decision-making. Whether salpingotomy should be offered depends on society's willingness to pay for an additional child.
  
  
  BACKGROUND
  Netherlands Organisation for Health Research and Development, Region Västra Götaland Health & Medical Care Committee.
  
  
  BACKGROUND
  ISRCTN37002267.
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands f.mol@amc.nl.
authors.forename: F
authors.initials: F
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: van Mello
authors.affiliation: Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Strandell
authors.affiliation: University College London Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
authors.affiliation: King's College Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Ross
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Yalcinkaya
authors.affiliation: Penn Fertility Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Barnhart
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: H R
authors.initials: HR
authors.lastname: Verhoeve
authors.affiliation: Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: G C
authors.initials: GC
authors.lastname: Graziosi
authors.affiliation: Máxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Koks
authors.affiliation: School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Ankum
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Hajenius
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Wely
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000191:economics*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000601:surgery*; D058994:Salpingectomy / Q000009:adverse effects* / Q000191:economics*; D012489:Salpingostomy / Q000009:adverse effects* / Q000191:economics*
keywords: cost-effectiveness; ectopic pregnancy; laparoscopy; randomized controlled trial; surgery