Objective: To analyze the financial implications of establishing a hysteroscopic sterilization program using the essure micro-insert tubal sterilization system in an outpatient clinic.
methods: a retrospective cohort study (Canadian task force classification type ii-2), in a women’s health outpatient clinic at a tertiary hospital, of 108 women who underwent to essure coil insertion between 2005 and 2006, and 104 women undergoing laparoscopic tubal sterilization for permanent sterilization between 2001 and 2004. essure procedures used a 4mm single-channel surgical hysteroscope and conscious sedation (fentanyl and midazolam) ; laparoscopic tubal sterilizations were completed under general anesthesia with a 7-mm laparoscope and bipolar cautery or filshie clips. Costs associated with the procedure, follow-up, and management of any complications (including nursing, hospital, equipment, and disposable charges) were tabulated.
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results: essure coils were successfully placed on the first attempt in 103 of 108 women (95%). three patients required a second attempt to complete placement and two patients required laparoscopic tubal sterilization after a failed trial. all 104 laparoscopic tubes were completed on the first attempt with no complications reported. the total cost of the 108 essure procedures, including follow-up evaluation, was $138,996 or $1,287 per case. the total cost associated with the 104 laparoscopic tubal sterilization procedures was $148,227 or $1,398 per case. the incremental cost-effectiveness ratio was $111.
Conclusions: The essure procedure in an outpatient setting resulted in a statistically significant cost savings of $111 per sterilization procedure. performing the essure procedure in an outpatient setting frees up space in the operating room for other types of cases, improving access to care for more patients.