Financial considerations among adult men undergoing vasectomy: cost analysis and modeling of outpatient costs associated with vasectomy

Abstract

Background: A noted barrier to men pursuing vasectomy is the out-of-pocket cost associated with the procedure and required follow-up. Published cost ranges vary widely, may be poor proxies for actual patient cost experience and often fail to include the cost associated with pre-procedure visits and post-vasectomy semen analyses (PVSAs). The study aims to identify a realistic total cost for men undergoing vasectomy.

Methods: We examine the charges and payments associated with a vasectomy procedure inclusive of any associated pre-procedure office visit, procedure, and follow-up semen analysis. Data on cost for the pre-procedure office visit and procedure were derived from actual charges/payments for 200 consecutive patients seen in a single medical system between 2022 and 2023. Cost of semen analyses were derived from patient-reported and/or published out-of-pocket costs for LabCorp™, local fertility clinic(s), and Fellow^®. Proceeding with the procedure after the initial visit, expected compliance with PVSAs, vasectomy success rates, and regret rate were based on published literature. A Monte-Carlo simulation model was then created with a modelled patient pool of 10,000 patients reflective of the payer mix, compliance, and success rates from the time point of presenting for initial consultation to generate models of total cost. As part of broader independent review board (IRB) approved survey of motivational factors amongst men undergoing vasectomy, a theme of cost emerged as a possible barrier to care. De-identified cost data was then combined with modeling described above.

Results: In Model 1 (maximum cost model), the base out-of-pocket cost was $350 plus the cost of PVSA ($139) for an estimated total of $489. The Model 1 average cost was $466. In Model 2 (minimum cost model), the base cost was $276 plus the cost of PVSA ($139) for an estimated total of $415. The Model 2 average cost was $384.42. When incorporating facility fee of $500 with variable insurance coverage, there is a wider range of out-of-pocket cost from $384.42 (full coverage in Model 2) to $1,026 (full facility fee out-of-pocket in Model 1).

Conclusions: Based on real-world patient data, there is a definable range of out-of-pocket cost for an insured patient including outpatient visit, vasectomy procedure and PVSA of $384-489. The main driver of variability in cost stemmed from facility fee and the insurer contribution toward this cost. This broadens the definable range of out-of-pocket cost to $384-1,026.

Keywords: Modeling; cost; vasectomy.

Figure 1

Model 1 (maximum cost model) with variable PVSA compliance and vasectomy failure rates. PVSA: patient undergoes standard PVSA at 10–12 weeks. PVSA compliance rate is shown on the X-axis. PVSA failure: patient undergoes standard PVSA at 10–12 weeks. Successful PVSA rates are shown on the X-axis (%). Repeat vasectomy: persistent PVSA failure requiring repeat vasectomy. Success of final PVSA on X-axis (%). Average PVSA compliance: assuming literature published rates of PVSA compliance. PVSA failure published: assuming published PVSA failure rate. Published repeat vasectomy: assuming published rate of repeat vasectomy in literature. PVSA, post-vasectomy semen analysis; USD, United States dollars.

Figure 2

Model 2 (minimum cost model) with variable PVSA compliance and vasectomy failure rates. PVSA: patient undergoes standard PVSA at 10–12 weeks. PVSA compliance rate is shown on the X-axis. PVSA failure: patient undergoes standard PVSA at 10–12 weeks. Successful PVSA rates are shown on the X-axis (%). Repeat vasectomy: persistent PVSA failure requiring repeat vasectomy. Success of final PVSA on X-axis (%). Average PVSA: assuming literature published rates of PVSA compliance. PVSA failure published: assuming published PVSA failure rate. Published repeat vasectomy: assuming published rate of repeat vasectomy in literature. PVSA, post-vasectomy semen analysis; USD, United States dollars.

Figure 3

Models 1 and 2 with a $500 facility fee. Out-of-pocket responsibility as a percentage to demonstrate range. Average cost from each model with variable insurance coverage of fixed facility fee. A 0% out-of-pocket represents full insurance coverage of facility fee. Model 1, maximum cost model; Model 2, minimum cost model. USD, United States dollars.