Literature Review Article
Cost-Effectiveness Analysis of Essure® Tubal Sterilization Procedure and Laparoscopic Tubal Sterilization. Thiel JA, Carson GD. J Obstet Gynaecol Can 2008; 30 (7): 581-585.
Sejal Dharia-Patel, M.D.
This study was a retrospective cohort study of 104 women undergoing laparoscopic tubal sterilization compared with 108 women undergoing Essure® coil insertion between 2005-2008. The authors’ objective was to compare the cost effectiveness of both procedures for sterilization.
Demographically, the two groups differed only in age with women undergoing an Essure® procedure being on average three years older than women undergoing laparoscopic sterilization. The groups were similar in gravidity, parity and BMI.
Essure® coils were placed successfully on the first attempt in 95% of patient using the single-channel operative hysteroscope with normal saline as the distending medium. Placement was confired using either ultrasound or a hysterosalpingogram. Three patients required a second attempt and two required laparoscopic tubal sterilization. All 104 laparoscopic tubal ligations were completed on the first attempt using either bipolar cautery or Filshie clips. Costs associated with the Essure® procedure included nursing, the device, follow-up ultrasound, hysterosalpingogram, complications and a laparoscopic tubal ligation. The total cost for the 108 Essure® procedures was either 138, 996 or 1287 per case. Costs associated with the laparoscopic tubal ligation included nursing care, hospital expenses, anesthesia, the Filshie clips, and the disposable instruments. The total cost of the four 104 laparoscopic tubal sterilization procedures was either 148, 227 or 1396 per case. The incremental cost-effectiveness ratio was $111.
Daniel B. Williams, M.D.
In this study, cost appears to be similar between the two procedures when both are done in a hospital setting. It would be interesting to see what the cost differences would be for office-based Essure® placement, which would be expected to significantly increase the cost differences between the two methods. It would also be important to include time off from work in the cost analysis.
The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.