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 pounds (95% confidence interval [CI] 1501 pounds-1656 pounds) for salpingectomy and 1787 pounds (95% CI 1683 pounds-1930 pounds) for conservative surgery. The mean difference between costs of salpingectomy and costs of conservative surgery was 233 pounds (95% CI 80 pounds-371 pounds). Concerning subsequent intrauterine pregnancy, conservative surgery is slightly more effective than salpingectomy but is more expensive. Costs per subsequent intrauterine pregnancy are 4063 pounds. 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 pounds. 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.