Is conservative surgery for tubal pregnancy preferable to salpingectomy? An economic analysis

Objective The traditional treatment of ectopic pregnancy is salpingectomy, while conservative surgery aims to save the function of the uterine tube. This study compares the effectiveness and the economic costs of salpingectomy and conservative tubal surgery in women with a tubal pregnancy. Methods Salpingectomy and conservative tubal surgery were compared economically, based on a combined retrospective and prospective cohort study and a review of the literature. A model was developed in which conservative surgery and salpingectomy with in vitro fertilisation and embryo-transfer (IVF-ET) were compared with salpingectomy alone. Participants One hundred and fifteen consecutive women treated laparoscopically for tubal pregnancy. Main outcome measures Complete removal of the tubal pregnancy; subsequent intrauterine pregnancy rate; economic analysis. Results Tubal pregnancy was always treated successfully by both methods, sometimes with additional treatment for persistent trophoblast. In the short term costs per patient were £1554 (95% confidence interval [CI] £1501-£1656) for salpingectomy and £1787 (95% CI £1683-£1930) for conservative surgery. The mean difference between costs of salpingectomy and costs of conservative surgery was £233 (95% CI £80-£371). Concerning subsequent intrauterine pregnancy, conservative surgery is slightly more effective than salpingectomy but is more expensive. Costs per subsequent intrauterine pregnancy are £4063. If IVF-ET is performed in all women who are not pregnant within three years after salpingectomy, costs per subsequent intrauterine pregnancy are £15,629. Conclusions Salpingectomy is the treatment of choice in women not desiring future pregnancy. Salpingectomy seems less effective than conservative surgery when future pregnancy is desired, but is less costly. Conservative surgery seems more cost effective than salpingectomy with additional IVF-ET.