Vasectomy More Cost-Effective Than Salpingectomy for Permanent Contraception, Reveals Research
USA: Researchers have found in a new cost-effectiveness analysis that vasectomy is a more cost-effective permanent contraceptive option. While salpingectomy prevented more unintended pregnancies and reduced ovarian cancer risk, it only became the more cost-effective option at higher willingness-to-pay levels.
The investigation, published in Obstetrics & Gynecology by Jill Brown, MD, MPH, of the Department of Gynecologic Surgery and Obstetrics at the Uniformed Services University in Bethesda, Maryland, compared the long-term economic value of the two procedures for couples seeking permanent contraception. Using a decision-tree model created in TreeAge, the researchers analyzed outcomes for a hypothetical cohort of 800,000 individuals—the approximate number of Americans who undergo permanent contraception each year.
Effectiveness was measured in quality-adjusted life-years (QALYs), with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained or lost. Cost estimates, probabilities, and utility values were sourced from existing medical literature.
The analysis calculated the incremental cost-effectiveness ratio (ICER) between salpingectomy and vasectomy and included a probabilistic sensitivity assessment with 10,000 simulations. A cost-effectiveness acceptability curve was then generated for WTP thresholds ranging from $0 to $200,000. Secondary outcomes included the number of unintended pregnancies as well as ovarian cancer cases and deaths.
The study revealed the following findings:
- Salpingectomy had an incremental cost-effectiveness ratio (ICER) of $143,769 per QALY gained compared with vasectomy, exceeding the standard $100,000 threshold.
- Vasectomy was more cost-effective in 81.5% of simulations at a willingness-to-pay (WTP) level of $100,000.
- The cost-effectiveness advantage of vasectomy dropped to 14.7% when the WTP threshold increased to $200,000, indicating salpingectomy may be more attractive when higher costs are acceptable.
- Salpingectomy was linked to 1,215 fewer unintended pregnancies annually compared with vasectomy.
- It was also associated with 6,085 fewer ovarian cancer cases each year.
- The procedure further resulted in 4,921 fewer ovarian cancer deaths, highlighting its broader public health benefits.
The authors concluded that, at a WTP threshold of $100,000, salpingectomy does not meet standard benchmarks for cost-effectiveness relative to vasectomy, despite its ability to lower both unintended pregnancy rates and the societal burden of ovarian cancer. They emphasized the importance of shared decision-making between healthcare providers and couples considering permanent contraception. According to the research team, counseling should incorporate not only the financial and contraceptive aspects of each procedure but also the long-term health benefits—particularly the reduction in ovarian cancer risk—associated with salpingectomy.
"The analysis highlights the nuanced balance between economic considerations and broader health outcomes when choosing a permanent contraceptive method, offering valuable insights for clinicians and couples making these critical decisions," the authors wrote.
Reference:
Pearson, Amy BS; Shvartsman, Katerina MD; Zeng, Wu MD, PhD; Brown, Jill MD, MPH. Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception. Obstetrics & Gynecology ():10.1097/AOG.0000000000006042, August 28, 2025. | DOI: 10.1097/AOG.0000000000006042
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