In the present manuscript [1], Mortach et al. examined vasectomy price variation and reporting practices among hospitals in the United States using publicly available data from the Turquoise database. While vasectomy is not one of the procedures for which mandatory reporting is required by the Centers for Medicare and Medicaid Services (CMS) Hospital Price Transparency Regulations [2], hospitals may still electively report this information. Only a quarter of these facilities elected to report vasectomy pricing, and those with more beds, more physicians, non-profit status, and located in a well-resourced area were more likely to do so. Reported pricing (and particularly self-pay pricing) in this database varied immensely and ranged from $124 to $14,339, with non-profit hospitals reporting lower pricing regardless of payor type.

This study raises at least two main points with deep societal implications. First, it is nearly inconceivable that a price difference eclipsing two orders of magnitude is justifiable for any practical reason, and this degree of variation may only be the tip of the iceberg given that only a minority of hospitals reported pricing. The importance of cost transparency across all of medicine, and particularly for common procedures with well-defined public health benefits and long-term cost savings, cannot be overstated. Second, the disparities in vasectomy cost and access in the US marketplace is a fundamental issue of reproductive and social justice. This is particularly important given the recent Dobbs ruling to overturn Roe v. Wade [3], a decision which simultaneously limited reproductive healthcare for women in many geographical (and often underprivileged) areas and triggered a significant increase in vasectomy procedure volume for men [4]. Prior research has demonstrated that black and Hispanic patients, those with low income, and those with less education are underrepresented among men receiving vasectomies [5,6,7]. Whether this is due to knowledge gaps, cultural aspects surrounding this sensitive topic, financial limitations, or other reasons remains unknown and should be further studied. The research presented here did reassuringly show that hospitals in lower income areas had lower average prices and that Medicare and Medicaid prices were (appropriately) similarly low amongst the facilities with data available. Even if access to high quality reproductive healthcare is available to men, however, the lack of cost transparency may make the difference between proceeding or foregoing the procedure, potentially with life-altering consequences.

Providers with expertise in the male reproductive system are in a unique position to not only provide high quality clinical care, but also to advocate for increased institutional pricing transparency in accordance with CMS guidelines. Doing so will ensure all men who desire to exercise their reproductive decision-making rights will have the opportunity to do so without the risk of unexpected additional financial burden. While the role of policymakers in reproductive rights remains a heated debate, few providers or patients would argue with guidelines expanding cost transparency as a first step towards improving access, parity, and healthcare quality for all.