title: Comparative Cost-Effectiveness Analysis of Modified 1-Layer versus Formal 2-Layer Vasovasostomy Technique.
abstract: OBJECTIVE
  Approximately 2% to 6% of men undergoing vasectomy will ultimately have it reversed. Cost is a major consideration for patients and providers with regard to vasovasostomy. Opportunities for cost savings for vasectomy reversal lie in the reduction of variable costs, namely operative time and materials used. In this study we determine the cost benefits of a modified 1-layer vasovasostomy compared to a formal 2-layer vasovasostomy.
  
  
  METHODS
  A retrospective analysis was performed of a single surgeon experience of vasectomy reversals performed from 2010 to 2015. The cohort consisted of men who underwent bilateral vasovasostomy using a formal 2-layer or modified 1-layer technique. The primary end points of the analysis were total operative time; number, cost and type of suture used; and patency/postoperative semen analysis. Bivariate analysis was performed for these continuous variables using the Wilcoxon rank test and the chi-square test was used for categorical variables.
  
  
  RESULTS
  Of the 106 men who underwent bilateral vasovasostomy 81.1% (86) had a formal and 18.9% (20) had a modified 1-layer repair. The modified 1-layer closure resulted in a significantly shorter operative time, lower microsuture cost and lower overall operative cost compared to formal repair (all p <0.05). There were no statistically significant differences in semen parameters between the 2 techniques at the first postoperative visit.
  
  
  CONCLUSIONS
  The modified 1-layer vasovasostomy resulted in shorter operative times and lower costs compared to formal repair without compromising postoperative patency. In this era of cost containment the modified repair provides the opportunity to perform vasectomy reversal at a lower cost to patients and providers.
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Yaw A
authors.initials: YA
authors.lastname: Nyame
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Paurush
authors.initials: P
authors.lastname: Babbar
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Nima
authors.initials: N
authors.lastname: Almassi
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Polackwich
authors.affiliation: Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: sabanee@ccf.org.
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabanegh
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055101:Semen Analysis; D016896:Treatment Outcome; D014659:Vasectomy / Q000191:economics; D014669:Vasovasostomy / Q000191:economics* / Q000379:methods*
keywords: cost-benefit analysis; operative; surgical procedures; vasovasostomy