IS CONSERVATIVE SURGERY FOR TUBAL PREGNANCY PREFERABLE TO SALPINGECTOMY - AN ECONOMIC-ANALYSIS

Objective The traditional treatment of ectopic pregnancy is salpingect omy, while conservative surgery aims to save the function of the uteri ne 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 co mpared 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 fertilisat ion and embryo-transfer (IVF-ET) were compared with salpingectomy alon e. Participants One hundred and fifteen consecutive women treated lapa roscopically for tubal pregnancy. Main outcome measures Complete remov al of the tubal pregnancy; subsequent intrauterine pregnancy rate; eco nomic analysis. Results Tubal pregnancy was always treated successfull y by both methods, sometimes with additional treatment for persistent trophoblast. In the short term costs per patient were pound 1554 (95% confidence interval [CI] pound 1501-pound 1656) for salpingectomy and pound 1787 (95% CI;pound 1683-pound 1930) for conservative surgery. Th e mean difference between costs of salpingectomy and costs of conserva tive surgery was pound 233 (95% CI pound 80-pound 371). Concerning sub sequent intrauterine pregnancy conservative surgery is slightly more e ffective than salpingectomy but is more expensive. Costs per subsequen t intrauterine pregnancy are pound 4063. If IVF-ET is performed in all women who are not pregnant within three years after salpingectomy, co sts per subsequent intrauterine pregnancy are pound 15,629. Conclusion s Salpingectomy is the treatment of choice in women not desiring futur e pregnancy Salpingectomy seems less effective than conservative surge ry when future pregnancy is desired, but is less costly. Conservative surgery seems more cost effective than salpingectomy with additional I VF-ET.