Dr Adjei on the Rationale for Opportunistic Salpingectomy for Ovarian Cancer Prevention

Naomi Adjei, MD, MPH, MSEd, gynecologic oncology fellow, The University of Texas MD Anderson Cancer Center, discusses the rationale investigating the cost-effectiveness of opportunistic salpingectomy for the primary prevention of ovarian cancer in patients undergoing nongynecologic abdominopelvic procedures and highlights the key findings from this research.

Ovarian cancer is a deadly disease that is also costly, Adjei begins. Patients with ovarian cancer tend to experience disease recurrence after receiving primary ovarian cancer treatment and receive several subsequent lines of therapy, Adjei says. The accumulated costs of these therapies over time can lead to financial toxicity for many patients, Adjei emphasizes. Furthermore, ovarian cancer management can affect quality of life for patients and their families, Adjei notes.

Opportunistic salpingectomy involves prophylactically removing the fallopian tubes, where ovarian cancer develops, Adjei explains. The procedure is performed at the time of gynecologic procedures, including hysterectomies, cesarean sections, and permanent sterilization surgeries, and can reduce the risk of ovarian cancer by approximately 65%, according to Adjei. Additionally, opportunistic salpingectomy is safe, not associated with earlier onset of menopause, and does not adversely affect ovarian reserve. However, the effects of broader implementation of opportunistic salpingectomy during nongynecologic procedures are unknown.

To address this knowledge gap, Adjei and colleagues assessed the cost-effectiveness of conducting fallopian tube removal during non-gynecological abdominopelvic procedures, including appendectomies, cholecystectomies, bariatric surgeries, colon resections, and abdominal hernia repairs.

This study included 40-year-old females who underwent any of the relevant abdominopelvic procedures in 2019 and had continuous insurance coverage. Adjei and coinvestigators found that opportunistic salpingectomy at the time of both gynecologic procedures and nongynecologic procedures was associated with lower treatment costs and higher benefits for patients, Adjei concludes. Among all patients’ procedures combined, the total net monetary benefit was $3,180,884 with opportunistic salpingectomy. Without opportunistic salpingectomy, the total net monetary benefit for patients was $2,660,624, translating to an incremental net monetary benefit of $520,260.