研究顯示，子宮外孕手術若保留輸卵管易造成日後再次發生子宮外孕
Hum Reprod. 2015 Sep;30(9):2038-47. doi: 10.1093/humrep/dev162. Epub 2015 Jul 13.
Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).
Mol F1,
van Mello NM2,
Strandell A3,
Jurkovic D4,
Ross JA5,
Yalcinkaya TM6,
Barnhart KT7,
Verhoeve HR8,
Graziosi GC9,
Koks CA10,
Mol BW11,
Ankum WM2,
van der Veen F12,
Hajenius PJ2,
van Wely M12;
European Surgery in Ectopic Pregnancy (ESEP) study group.
Abstract
STUDY QUESTION:
Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube?
SUMMARY ANSWER:
Salpingotomy 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 ALREADY:
Women 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, DURATION:
We 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, METHODS:
We 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 CHANCE:
Mean 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.
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