Elsevier

Journal of Minimally Invasive Gynecology

Volume 14, Issue 1, January–February 2007, Pages 97-102
Journal of Minimally Invasive Gynecology

Original article
Retrospective cost analysis comparing Essure hysteroscopic sterilization and laparoscopic bilateral tubal coagulation

A preliminary report of this study was presented at the 33rd annual meeting of the American Association of Gynecologic Laparoscopists, San Francisco, California, November 10–13, 2004.
https://doi.org/10.1016/j.jmig.2006.10.001Get rights and content

Abstract

Study objective

To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation.

Design

Retrospective cohort study (Canadian Task Force classification II-2).

Setting

Midwestern academic medical center.

Patients

Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied.

Interventions

Placement of the Essure inserts according to the manufacturer’s instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy.

Measurements and main results

Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was $180 (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p <.0001), but this was offset by higher charges for operating room costs, which included the recovery room (p <.0001) and pharmacy costs (p <.0001) in the patients in the laparoscopy group.

Conclusion

In our setting, the Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.

Section snippets

Patient selection

There were 56 Essure procedures performed at our institution from January 1, 2003, through August 31, 2004. For comparison, all patients at our institution undergoing a tubal sterilization procedure from January 1, 2003, through December 31, 2003, were identified from a surgical database maintained by the division of gynecologic surgery within our department. This included 50 interval tubal sterilizations by bilateral tubal coagulation. Other laparoscopic approaches such as the Filshie clip

Results

The demographics of the patients in the 2 groups were similar, although some minor differences existed (Table 1). The mean age of the 2 groups was similar (p = .509), but the age range was greater in the Essure group. The youngest patients in the Essure group had specific medical conditions that required reliable permanent contraception with minimal surgical risk for the procedure by avoiding surgical incisions and general anesthesia. There were 3 such patients in the Essure group (7%), and 2

Discussion

This review of our patient database establishes that Essure hysteroscopic sterilization provides a significant cost advantage over laparoscopic tubal sterilization in an operating room setting. Although we found a relatively modest reduction in cost, the cost savings to the health care system could be quite dramatic given the number of interval sterilizations performed annually.1 An estimate of potential savings, assuming 350 000 interval sterilizations performed each year in the United States,1

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    • Cited by (0)

    None of the authors have any financial interest in any of the commercial products contained in this report, and no external financial support was received for completing this study.

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    Copyright © 2007 AAGL. Published by Elsevier Inc. All rights reserved.