Costs and Complications Associated with Tubal Ligation

Madrid—A database analysis of women <50 years of age who received a tubal ligation and had continuous insurance coverage for 1 year after the procedure found that a substantial number of patients experienced complications, which were associated with high costs. The results were presented at the ISPOR European Congress in a poster titled Complications and Costs Associated with Tubal Ligations. The authors noted that tubal ligation is a popular form of contraception and cited a study that estimated 17.0% of women in the United States have had tubal ligation to prevent pregnancy. They mentioned that the procedure fails to prevent pregnancy only 0.5% of the time during the first year, but women may experience infections or surgical complications. The procedure is also more expensive than other forms of contraception. In this study, the authors examined information from a database maintained by i3, a research organization. The database included patient demographics as well as inpatient, outpatient, and prescription drug claims from January 1, 2006, through March 31, 2010. The study included 15,169 women <50 years of age in the United States who had a tubal ligation. The mean age was 35.26 years, and 97.78% of the women had commercial insurance. The remaining 2.22% had Medicaid. The most common type of insurance was point of service (66.16% of patients), followed by exclusive provider organization (18.35%), and health maintenance organization (11.04%). The authors found that 21.28% of women had ≥1 complication after undergoing tubal ligation: 14.44% experienced heavy menstrual bleeding, 4.81% had surgical complications, 4.07% had dysmenorrhea, 2.07% had sepsis, 1.82% had hysterosalpingogram, 1.26% became pregnant, 1.14% had a postoperative infection, 0.55% had menorrhagia, and 0.38% had an ectopic pregnancy. The mean charge for the procedure was $9936; the mean charge for the complications for all of the women was $8112. However, the mean charge for the 3228 women who had complications after undergoing tubal ligation was $37,425. From 2007 through 2009, there was a statistically significant increase (P<.05 in each case) in the diagnoses of heavy menstrual bleeding (13.47% to 17.28%), surgical complications (4.42% to 6.03%), sepsis (1.79% to 2.72%), and any complication (20.26% to 25.89%). However, there was no statistically significant change over the same time period in dysmenorrhea, menorrhagia, postoperative infection, pregnancy after tubal ligation, or ectopic pregnancy after tubal ligation. The mean cost for a tubal ligation rose from $9823 in 2007 to $10,207 in 2009, although the increase was not statistically significant. However, the increases associated with complications related to the procedure were statistically significant. The mean charge for the complications among all women was $7442 in 2007 and $11,176 in 2009, while the mean charge among only the women who had complications was $36,831 in 2007 and $43,161 in 2009 (P<.05 in both cases). The authors noted that because they only used a database of patients with medical and outpatient prescription benefits, the results may not be consistent for all populations. Another potential limitation is that rather than formal diagnostic assessments, the authors used less rigorous diagnostic codes. In addition, the study’s descriptive design did not permit the authors to predict factors associated with complications or charges incurred after the women had the procedure. This study was supported by Teva Pharmaceuticals.