Cost-Effectiveness Analysis of Vasovasostomy Techniques
Urology – September 30, 2016 – Vol. 34 – No. 7
The authors found decreased costs without compromises to surgical outcomes with the modified 1-layer vasovasostomy technique.
Article Reviewed: Comparative Cost-Effectiveness Analysis of Modified 1-Layer Versus Formal 2-Layer Vasovasostomy Technique. Nyame YA, Babbar P, et al: J Urol; 2016;195 (February): 434-438.
Background: Roughly 20% of men who undergo vasectomy will desire children in the future, and somewhere between 2% and 6% of men who have a vasectomy will ultimately get it reversed. Vasectomy reversal is generally an out-of-pocket cost for patients, and the economically conscious physician will attempt to limit this cost burden to patients. Previous study has found that the modified 1-layer technique does not reduce patency in men.
Objective: To compare surgical costs between the traditional 2-layer technique and a modified 1-layer technique.
Design: Retrospective review.
Methods: This review looked at just over 5 years of single surgeon data. Men were excluded if this was not their first attempt at vasectomy reversal or if the indication was for something other than resuming fertility. Patients who underwent vasoepididymostomy were also excluded. A review of the electronic medical records, operating room (OR) data, and OR charges was used to obtain the data. Patency was defined either by presence of sperm on first semen analysis or obtaining pregnancy.
Results: The modified 1-layer technique was used primarily in the last 10 months of the study period and was used in 20 of 106 men who were able to be included. Suture costs were significantly less in this group, along with costs associated with OR time and the overall cost of the procedure. Patency rates were 93% for the 1-layer technique and 89% for the traditional 2-layer technique (P =0.22).
Conclusions: The modified 1-layer vasovasostomy appears to be less expensive than the traditional 2-layer technique without compromising surgical outcomes.
Reviewer’s Comments: With roughly 500,000 vasectomies performed yearly in the United States, surely some of these men will have life changes that bring them back to the urologist to discuss a reversal. Although biologically related children can be obtained either through a vasectomy reversal or in vitro fertilization, these are infrequently covered by health insurance providers with costs passed on to the patient. The costs associated with these techniques can be considerable ranging in the thousands to tens of thousands of dollars. Although generally a bundled cost at most institutions, the ability to decrease these costs to the patient could eventually lower the bundle cost and potentially allow patients to afford vasectomy reversal. In addition, lowering costs associated with vasectomy reversal can make this more competitive with IVF cycles and also allows the couple to conceive multiple times without additional costs. The findings that the patency rates are unchanged with this less-expensive modified 1-layer technique are important and reassuring.(Reviewer–Charles Welliver, MD).