• F Mol, N M van Mello, A Strandell, D Jurkovic, J A Ross, T M Yalcinkaya, K T Barnhart, H R Verhoeve, G C Graziosi, C A Koks, B W Mol, W M Ankum, F van der Veen, P J Hajenius, M van Wely, and European Surgery in Ectopic Pregnancy (ESEP) study group.
• Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands f.mol@amc.nl.
• Hum. Reprod. 2015 Sep 1; 30 (9): 2038-47.

Study QuestionIs salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube?Summary AnswerSalpingotomy 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.What Is Known AlreadyWomen 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.Study Design, Size, DurationWe 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.Participants/Materials, Settings, MethodsWe 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.Main Results And The Role Of ChanceMean 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.Limitations, Reasons For CautionCosts of any subsequent IVF cycles were not included in this analysis. The analysis was limited to the perspective of the hospital.Wider Implications Of The FindingsHowever, 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.Study Funding/Competing InterestsNetherlands Organisation for Health Research and Development, Region Västra Götaland Health & Medical Care Committee.Trial Registration NumberISRCTN37002267.© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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