High variability in self-pay pricing for vasectomy and vasectomy reversal in the United States.

CONTEXT: In the United States (US) men who undergo vasectomy and/or vasectomy reversal (vasovasotomy) are likely to pay out-of-pocket for these procedures. We characterized the publicly disclosed pricing of both procedures with a focus on variability in self-pay prices. METHODS: We queried all US hospitals for publicly disclosed prices of vasectomy and vasovasotomy. We assessed interhospital variability in self-pay pricing and compared hospitals charging high (≥75th percentile) and low (≤25th percentile) self-pay prices for either procedure. We also examined trends in pricing after the 2022 US Supreme Court decision that allowed individual states to ban abortion. RESULTS: Of 6692 hospitals, 1375 (20.5%) and 281 (4.2%) disclosed self-pay prices for vasectomy and vasovasotomy, respectively. There was a 17-fold difference between the 10th and 90th percentile self-pay prices for vasectomy ($421-$7147) and a 39-fold difference for vasovasotomy ($446-$17,249). Compared with hospitals charging low (≤25th percentile) self-pay prices for vasectomy or vasovasotomy, hospitals charging high (≥75th percentile) prices were larger (median 150 vs. 59 beds, p < 0.001) and more likely to be for-profit (31.2% vs. 7.8%, p < 0.001), academic-affiliated (52.7% vs. 23.1%, p < 0.001), and located in an urban zip code (70.1% vs. 41.3%, p < 0.001). From October 2022 to April 2023, the median self-pay price of vasectomy increased by 10% (from $1667 to $1832) while the median self-pay price of vasovasotomy decreased by 16% (from $3309 to $2786). CONCLUSION: We found large variability in self-pay pricing for vasectomy and vasectomy reversal, which may serve as a barrier to the accessibility of male reproductive care.

Use of Office Versus Ambulatory Surgery Center Setting and Associated Ancillary Services on Healthcare Cost Burden for Vasectomy Procedures.

OBJECTIVE: To analyze variation in total healthcare costs for vasectomies performed in the United States, based on procedure setting and use of ancillary pathology services. METHODS: We queried the MarketScan Commercial Claims database using CPT, ICD, and HCPCS codes to identify men who underwent vasectomy between 2009 and 2015, either in the office or ambulatory surgical center (ASC) setting, with or without use of pathology services. All payments for each treatment episode were calculated based on relevant claims. Patient out-of-pocket expenses were defined as the sum of copayments, coinsurance, and deductibles for each claim. Trends in vasectomy use, and differences in procedure costs by practice setting were compared over the study period. RESULTS: 453,492 men underwent a vasectomy between 2009 and 2015. The number of procedures decreased from 76,197 in 2009 to 37,575 in 2015 (P = .002). Average procedural costs increased from $870 in 2009 to $938 in 2015 (P = .001). Overall, 82.6% and 17.4% of procedures were performed in the office vs ASCs, respectively. In-office procedures were associated with lower total healthcare costs ($707 vs $1851) and lower patient out-of-pocket expenses ($173 vs $356) than those performed in ASCs. Vasal segments were submitted for pathologic evaluation in 40% of cases, which increased average payments by 55%. The use of ASCs and ancillary pathology services for vasectomies performed during the study period increased vasectomy-associated costs by $64 million. CONCLUSION: The unnecessary use of ASCs and ancillary pathology services for vasectomy may lead to tens of millions of dollars in potentially avoidable healthcare costs annually.

[Evaluation of practices and costs of vasectomy. French monocentric experience]. / Évaluation des pratiques et des coûts de la vasectomie. Expérience monocentrique française.

INTRODUCTION: Since the law of 4 July 2001, vasectomy has been recognized as a method of male contraception. We report the experience of vasectomy practice in a hospital-university center. METHODS: A monocentric retrospective cohort study of 45 patients who benefited from a contraceptive vasectomy between July 2001 and May 2016. For each patient were studied: modalities of implementation, compliance with the recommendations of the 2001 law, costs and benefits generated by the intervention, the effectiveness of the gesture on the control spermograms, the satisfaction of the patients by a telephone questionnaire. RESULTS: The mean age was 41.3 years. The second consultation was carried out in 91 % of the cases but the reflection period was not respected in 24 % of the cases. Written consent was signed in 89 % of cases. Vasectomy was performed on an outpatient basis in 73 % of cases, under local anaesthesia in 6.7 % of cases. The average cost per patient was 660.63 euros for an average gain of 524.50 euros, a loss of 136.13 euros. On the control spermogram, 54.3 % were azoosperms but the 3-month delay was not observed in 23 % of them. No patients expressed regret after surgery. CONCLUSION: The recommendations of the 2001 law were not systematically followed. This lack of standardization of practices, potential reflection of a lack of interest, is to be highlighted with the extra cost generated. The revaluation of the act should be integrated into the reflection of improvement of male sterilization practices. LEVEL OF PROOF: 4.

Comparative Cost-Effectiveness Analysis of Modified 1-Layer versus Formal 2-Layer Vasovasostomy Technique.

PURPOSE: Approximately 2% to 6% of men undergoing vasectomy will ultimately have it reversed. Cost is a major consideration for patients and providers with regard to vasovasostomy. Opportunities for cost savings for vasectomy reversal lie in the reduction of variable costs, namely operative time and materials used. In this study we determine the cost benefits of a modified 1-layer vasovasostomy compared to a formal 2-layer vasovasostomy. MATERIALS AND METHODS: A retrospective analysis was performed of a single surgeon experience of vasectomy reversals performed from 2010 to 2015. The cohort consisted of men who underwent bilateral vasovasostomy using a formal 2-layer or modified 1-layer technique. The primary end points of the analysis were total operative time; number, cost and type of suture used; and patency/postoperative semen analysis. Bivariate analysis was performed for these continuous variables using the Wilcoxon rank test and the chi-square test was used for categorical variables. RESULTS: Of the 106 men who underwent bilateral vasovasostomy 81.1% (86) had a formal and 18.9% (20) had a modified 1-layer repair. The modified 1-layer closure resulted in a significantly shorter operative time, lower microsuture cost and lower overall operative cost compared to formal repair (all p <0.05). There were no statistically significant differences in semen parameters between the 2 techniques at the first postoperative visit. CONCLUSIONS: The modified 1-layer vasovasostomy resulted in shorter operative times and lower costs compared to formal repair without compromising postoperative patency. In this era of cost containment the modified repair provides the opportunity to perform vasectomy reversal at a lower cost to patients and providers.

Bringing men to the table: sterilization can be for him or for her.

Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization.

Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study.

PURPOSE: It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011. MATERIALS AND METHODS: We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model. RESULTS: A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r=0.556, p<0.001) and personal income per capita (r=0.276, p=0.002). The number of reversals per month negatively correlated with the unemployment rate (r=-0.399, p<0.001) and personal income per capita (r=-0.305, p<0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators. CONCLUSIONS: We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions.

Reconsidering racial/ethnic differences in sterilization in the United States.

OBJECTIVE: Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner's vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced. STUDY DESIGN: Using the 2006-2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status. RESULTS: Women's chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups. CONCLUSIONS: Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies. IMPLICATIONS: Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies.

A novel cost-effective approach to post-vasectomy semen analysis.

OBJECTIVE: • To examine compliance, clearance rates and cost-effectiveness of a novel approach to managing men following vasectomy based on the testing of sperm viability. PATIENTS AND METHODS: • Between January 2003 and March 2005, 832 men undergoing vasectomy were followed prospectively for a minimum of 12 months. • Post-vasectomy semen analysis (PVSA) was carried out at 16 weeks with repeat at 20 weeks only if sperm were detected on initial PVSA i.e. a single clear PVSA on simple microscopy was deemed sufficient for declaring vasectomy successful. • In men with persistent non-motile sperm (PNMS) in the second specimen, comprehensive analysis of number and viability of sperm using a fluorescent probe was carried out on a fresh semen specimen taken in accordance with British Andrology Society (BAS) guidelines. RESULTS: • Overall compliance with the PVSA protocol was 81.3% (95% CI 78.5 to 83.8). No sperm were seen in 540 (78.8%) and 70 (10.3%) at the initial and 2(nd) PVSA respectively. • Persistent spermatozoa at 20 weeks were present in 66 (9.8%, 7.8 to 12.2) cases with 58 (8.6%, 6.7 to 11.0) having PNMS and 8 (1.2%, 0.6 to 2.3) having motile sperm. • Fluorescent viability testing in 53 of the 58 with PNMS showed viable sperm in 2 (3.8%, 1.0 to 12.8). The failure rate of vasectomy defined by PVSA (8 with motile sperm on 2(nd) PVSA and 2 with viable non-motile sperm on fluorescent testing) was 1.2% (0.7 to 2.2). • Average cost per vasectomy of PVSA using this protocol was £10.77 (US$ 16.67) compared with a minimum likely average cost using BAS guidelines of £18.10 (US$ 28). CONCLUSION: • Demonstrating absence of sperm on simple light microscopy in a single specimen of semen at 16 or 20 weeks post-vasectomy and reserving comprehensive testing of sperm viability for only the higher risk group with PNMS improves compliance and represents a cost-effective strategy for declaring surgical success. This reduces the costs of PVSA by least 40% compared with adherence with BAS guidelines without compromising success in determining outcome after vasectomy.

The law and vasectomy.

This article explores why the national court system has seen a steady influx of claims alleging practitioners' failure properly to perform vasectomy or ensure sterilization and the manner in which that influx has caused physicians to reassess their methods of practicing medicine in an increasingly litigious environment and make the appropriate and necessary accommodations. Through their experiences as medical malpractice litigators and through the analysis of reported cases, national jury verdicts, and insurance claims made and paid in lawsuits arising from claims regarding the performance of vasectomy, the authors enlighten the reader as to the legal theories and hurdles applicable to such claims and the medical theories most often elucidated and litigated by the patients who bring them. Also offered are suggestions as to the manner in which the practitioner may be proactive in both preventing and defending exposure to malpractice litigation.

Fascial interposition technique for vasectomy: is it justified?

PURPOSE: To assess the feasibility of the fascial interposition (FI) technique to improve the results of non-scalpel vasectomy (NSV) through a cost-effective modification. PATIENTS AND METHODS: The outcome of the FI technique for NSV in 954 consecutive candidates treated by two surgeons was evaluated retrospectively. 726 (76%) of the clients had undergone NSV with FI (FI group) and for the other 228 (24%) NSV by simple ligation and excision (LE) without FI (NFI group) was performed. Demographic data, operative time and complications as well as vasectomy failures were analyzed between the two groups. RESULTS: The two groups were age-matched and there were no significant differences between the two procedures regarding operative complications and operative time. 13 cases of vasectomy failures (5.7%) were detected after 3 months of follow-up, all in the NFI group. No vasectomy failure was recognized in the FI group. CONCLUSION: Combined use of FI with simple LE could be considered a simple effective method for NSV with a high success rate that allows the NSV to remain as a reliable option for contraception.

Cost effectiveness of contraceptives in the United States.

BACKGROUND: The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer's perspective. METHODS: A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. RESULTS: Any contraceptive method is superior to "no method". The three least expensive methods were the copper-T intrauterine device (IUD) (US$647), vasectomy (US$713) and levonorgestrel (LNG)-20 intrauterine system (IUS) (US$930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy and plan disenrollment rates. CONCLUSION: The copper-T IUD, vasectomy and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy and time horizon are influential factors that determine the overall value of a contraceptive method.

Factors affecting vasectomy acceptability in Tanzania.

CONTEXT: Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple and effective method of contraception, but is underused worldwide. METHODS: Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making. RESULTS: Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure. CONCLUSIONS: Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decision- making process will enable vasectomy promotion programs to more successfully target appropriate populations.

Determining the success of vasectomy.

OBJECTIVES: To examine patient compliance, significance of rare nonmotile sperm (RNMS) and to determine the timing and number of semen analyses required to confirm sterility. PATIENTS AND METHODS: From November 2001 to November 2004, 436 consecutive primary vasectomies were performed by one surgeon. All patients were instructed to submit two initial semen specimens for analysis (2 and 3 months after vasectomy) and additional samples (at 1-month intervals) if sperm were identified on the initial and subsequent analyses. RESULTS: A quarter of the patients submitted no semen specimens and only 21% followed the full instructions to provide two consecutive negative semen analyses. Three-quarters of the patients provided a semen specimen at 8 weeks after vasectomy; of these, 75% were azoospermic and 25% contained sperm. At 12 weeks after vasectomy half the patients provided a semen specimen; of these, 91% were azoospermic and 9% contained sperm. Of the 83 patients with semen containing sperm at 8 weeks, 80 had RNMS and three had rare motile sperm (one of whom subsequently proved to have vasectomy failure). Of the 80 patients with RNMS, at 3, 4, 5, 6, 8, 10 and 11 months, 65, four, three, four, two, one and one, respectively were azoospermic. CONCLUSIONS: The present results indicate that many patients are not compliant with the protocol after vasectomy. Provided patients have been adequately counselled, we think that one negative semen analysis at 3 months or one with RNMS at 2 months may be adequate to determine the success of vasectomy. This should reduce the number of semen analyses, including reducing the number of men who must undergo repeat testing, without sacrificing the accuracy of determining paternity. Simplifying the follow-up after vasectomy is important; not only would it be cost-effective but it may also improve patient compliance.

Characteristics of men receiving vasectomies in the United States, 1998-1999.

CONTEXT: Even though vasectomy is a popular method of contraception in the United States, there is limited information on the characteristics of men choosing vasectomy and why they decide to undergo the procedure. METHODS: A nationwide, practice-based survey of 719 men receiving vasectomies was conducted between July 1998 and June 1999. RESULTS: Low-income, minority and less educated men were underrepresented among vasectomy recipients. The majority of men were married or cohabiting (91%), non-Hispanic and white (87%), and educated beyond high school (81%). Only 7% of men had annual household incomes of less than $25,000, and fewer than 1% paid for the procedure using public funding; 81% of respondents paid through private insurance or a health maintenance organization. Half of men reported choosing vasectomy over a reversible method because it is the most secure means of preventing pregnancy, and 62% chose vasectomy over tubal ligation because the procedure is simpler and safer. Doctors and nurses were the most important sources of information about vasectomy (cited by 31% of respondents), followed by wives or partners (25%) and friends (23%). CONCLUSIONS: Despite the diversity of the U.S. population, vasectomy recipients are a homogeneous group. By identifying users of vasectomy and underserved groups, our findings should assist service providers and program managers in planning strategies to reduce the large difference in levels of vasectomy use among men of different races, ethnicities and income groups.