Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences.

CONTEXT: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5% to 20% of women of reproductive age. The economic burden of PCOS was previously estimated at approximately $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, without considering the costs of pregnancy-related and long-term morbidities. OBJECTIVE: This study aimed to estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS. METHODS: PubMed, EmBase, and Cochrane Library were searched, and studies were selected in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health, or Androgen Excess and PCOS Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index were included. Two investigators working independently extracted data on study characteristics and outcomes. Data were pooled using random effects meta-analysis. The I2 statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. RESULTS: The additional total healthcare-related economic burden of PCOS due to pregnancy-related and long-term morbidities in the United States is estimated to be $4.3 billion annually in 2020 USD. CONCLUSION: Together with our prior analysis, the economic burden of PCOS is estimated at $8 billion annually in 2020 USD.

Pregnancy outcome and cost-effectiveness comparisons of artificial cycle-prepared frozen embryo transfer with or without GnRH agonist pretreatment for polycystic ovary syndrome: a randomised controlled trial.

OBJECTIVE: To compare the live birth rate and cost effectiveness of artificial cycle-prepared frozen embryo transfer (AC-FET) with or without GnRH agonist (GnRH-a) pretreatment for women with polycystic ovary syndrome (PCOS). DESIGN: Open-label, randomised, controlled trial. SETTING: Reproductive centre of a university-affiliated hospital. SAMPLE: A total of 343 women with PCOS, aged 24-40 years, scheduled for AC-FET and receiving no more than two blastocysts. METHODS: The pretreatment group (n = 172) received GnRH-a pretreatment and the control group (n = 171) did not. Analysis followed the intention-to-treat (ITT) principle. MAIN OUTCOME MEASURES: The primary outcome measure was live birth rate. Secondary outcome measures included clinical pregnancy rate, implantation rate, early pregnancy loss rate and direct treatment costs per FET cycle. RESULTS: Among the 343 women randomised, 330 (96.2%) underwent embryo transfer and 328 (95.6%) completed the protocols. Live birth rate according to ITT did not differ between the pretreatment and control groups [85/172 (49.4%) versus 92/171 (53.8%), absolute rate difference -4.4%, 95% CI -10.8% to 2.0% (P = 0.45). Implantation rate, clinical pregnancy rate and early pregnancy loss rate also did not differ between groups, but median direct cost per FET cycle was significantly higher in the pretreatment group (7799.2 versus 4438.9 RMB, OR = 1.9, 95%CI 1.2-3.4, P < 0.001). Median direct cost per live birth was also significantly higher in the pretreatment group (15663.1 versus 8189.9 RMB, odds ratio [OR] = 1.9, 95% CI 1.2-3.8, P < 0.001). CONCLUSIONS: Pretreatment with GnRH-a does not improve pregnancy outcomes for women with PCOS receiving AC-FET, but significantly increases patient cost. TWEETABLE ABSTRACT: For women with PCOS, artificial cycle-prepared FET with GnRH agonist pretreatment provides no pregnancy outcome benefit but incurs higher cost.

Cost-effectiveness analysis of polycystic ovary syndrome management and the risk of gestational diabetes in pregnant women: a decision-tree model.

BACKGROUND: This study estimated the cost-effectiveness of metformin to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health-care payer perspective. METHODS: A decision tree was developed to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women diagnosed with PCOS and two scenarios were tested. Normal glucose regulation without developing GDM, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed through pregnancy. Evidence from randomized clinical trials and other published literature were used to assess disease progression and its associated health-care costs. Sensitivity analyses that varied key model parameters were conducted. RESULTS: Management of PCOS with metformin was associated with lowest ACER ($669.78 per normal glucose regulation without GDM) as compared to 'no intervention' strategy. Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $7,593,372.97 and an average effect gain of 2271 of normal glucose regulation without GDM among pregnant women with PCOS. Sensitivity analyses determined that the results are robust. CONCLUSIONS: Management of PCOS during pregnancy may be a cost-effective strategy to reduce GDM risk and its associated complications.

Incidence and prevalence of diabetes and cost of illness analysis of polycystic ovary syndrome: a Bayesian modelling study.

STUDY QUESTION: What is the incidence/prevalence of type 2 diabetes in women with polycystic ovary syndrome (PCOS) and the economic burden associated with PCOS in the UK? SUMMARY ANSWER: The incidence and prevalence of type 2 diabetes in women with PCOS are 3-33 per 1000 person years and 26.5%, respectively, with an associated annual healthcare burden of at least £237 million in the UK. WHAT IS KNOWN ALREADY: Although observational studies have been designed to assess the incidence of diabetes in women with PCOS, these have been open to criticism because of short periods of follow-up, small sample sizes or invalidated diagnosis of PCOS. Only one study has estimated the healthcare-related economic burden of PCOS, reporting a cost of $4.36 billion per year in the USA. STUDY DESIGN, SIZE, DURATION: This was a modelling study using individual patient data from a UK primary care database between 2004 and 2014 and aggregate data from the literature to obtain conversion rates through disease progression of PCOS. A simulation approach was applied to model the population dynamics of PCOS over a follow-up period of 25 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 14 135 women with PCOS or symptoms indicative of PCOS were selected from the primary care database to estimate the incidence of confirmed diagnosis of PCOS and diagnosis of type 2 diabetes. A 'virtual' cohort including the entire PCOS population (size estimated from the UK census data) was simulated to model the population dynamics of PCOS. The economic and utility analyses were further conducted from a healthcare perspective. MAIN RESULTS AND THE ROLE OF CHANCE: The peak conversion rate from possible to diagnosed PCOS was 121 per 1000 person-year (PY). The maximal incidence of type 2 diabetes was 33 per 1000 PY. The estimated prevalence of diabetes in the PCOS population was 26.5% (95% interval: 25.4-27.8%) during a 25-year follow-up. The annual healthcare burden of PCOS based on our conservative estimate is at least £237 million for the follow-up period examined. LIMITATIONS, REASONS FOR CAUTION: Due to lack of data, a full economic evaluation including healthcare costs of all the comorbidities associated with PCOS was not possible. Simplification of the real-world situation represented by the model may be a concern. WIDER IMPLICATIONS OF THE FINDINGS: This study suggests that a large number of women with symptoms indicative of PCOS never receive a definitive diagnosis yet can suffer from a rapid conversion to diabetes. This significantly reduces the quality of life for individual patients and incurs high costs for healthcare providers. As the risk of diabetes in women with PCOS is similar to that seen in populations at high risks of diabetes, it is possible that including them in national screening programmes may be cost effective. STUDY FUNDING/COMPETING INTEREST(S): There was no funding for the current study. There are no conflicts of interest. TRIAL REGISTRATION NUMBER: Not applicable.

Perspectives on Polycystic Ovary Syndrome: Is Polycystic Ovary Syndrome Research Underfunded?

Context: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic abnormality with a worldwide prevalence of 4% to 21%, depending on diagnostic criteria. The National Institutes of Health (NIH) is the largest single funding agency in the world; it invests nearly $30.0 billion annually in biomedical research. Evidence Acquisition: Using the NIH Research Portfolio Online Reporting tool, we searched for all grants awarded by the NIH for PCOS and three other disorders with similar degrees of morbidity and similar or lower mortality and prevalence [rheumatoid arthritis (RA), tuberculosis (TB), and systemic lupus erythematosus (SLE)]. Evidence Synthesis: We compared funding by the NIH for PCOS, RA, TB, and SLE research for the years 2006 to 2015, inclusive. Conclusion: PCOS, compared with RA, TB, and SLE, was relatively less funded (total mean 10-year funding was $215.12 million vs $454.39 million, $773.77 million, and $609.52 million, respectively). Funding for PCOS was largely provided by one NIH Institute/Center (ICs) vs at least two ICs for SLE and RA; more individual Research Project Grants were awarded for RA, SLE, and TB than for PCOS, whereas PCOS funding was more likely to be through General Clinical Research Centers Program or Specialized Centers Program awards. Our data suggest that PCOS research may be underfunded considering its prevalence, economic burden, metabolic morbidity, and negative impact on quality of life. Greater education of NIH leaders, including those at the National Heart, Lung, and Blood Institute and National Institutes of Diabetes and Digestive and Kidney Diseases; other federal and state agency leads; elected leaders; and the general public by professional societies, the scientific community, and patient advocates regarding this disorder is needed.

Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis.

BACKGROUND: Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives. METHODS: A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children. RESULTS: The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967). CONCLUSION: This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The aims of this study were to provide an estimate of the prevalence of PCOS in clinical practice; compare the risk of established cardiovascular risk factors, cardiovascular disease, and other comorbid conditions in women with PCOS to that of age- and race-matched controls; and explore the total costs of care that can be attributed to PCOS. METHODS: Louisiana Medicaid claims data were used to identify women with PCOS or its defining features and a control group in a ratio of 1:3. The prevalence of PCOS, cardiovascular risk factors (diabetes, dyslipidemia, dysmetabolic syndrome, glucose intolerance, hypertension, and obesity), key comorbidities (anxiety, bipolar disorders, depression, eating disorders, infertility, obstructive sleep apnea), and diagnosed cardiovascular disease were measured. RESULTS: During 2010, the prevalence of PCOS was 0.88%. Women with PCOS were more likely to have a diagnosis of diabetes (odds ratio [OR], 4.35; 95% confidence interval [CI], 3.63-5.21), dyslipidemia (OR, 3.56; 95% CI, 3.04-4.19), dysmetabolic syndrome (OR, 23.46; 95% CI, 13.64-40.36), glucose intolerance (OR, 5.46; 95% CI, 3.10-9.60), hypertension (OR, 2.76; 95% CI, 2.41-3.18), obesity (OR, 5.79; 95% CI, 5.07-6.62), infertility (OR, 23.42; 95% CI, 10.63-51.61), obstructive sleep apnea (OR, 6.47; 95% CI, 3.62-11.55), anxiety (OR, 1.76; 95% CI, 1.53-2.04), bipolar disorders (OR, 1.94; 95% CI, 1.55-2.44), and depression (OR, 2.22; 95% CI, 1.94-2.54) than did controls. Average total costs of care for the year was $5551 in the PCOS group and $3496 in the control group. After controlling for the effects of other variables, the average total cost of care for PCOS was $637 higher than that of the control group. Other variables that contributed significantly to the total costs of care included race, age, acute myocardial infarction, transient ischemic attack, peripheral artery disease, anxiety, depression, bipolar disorders, hypertension, diabetes, and dyslipidemia. CONCLUSIONS: Although the clinical burden of PCOS is high, it is diagnosed less frequently in clinical practice compared with systematic screening studies. This is concerning considering that PCOS is associated with cardiovascular risk factors and other comorbidities. Mean total costs of care for the PCOS group was higher than the mean total costs of care for the control group. Polycystic ovary syndrome is independently associated with an increase in mean total costs of care.

Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate.

This study evaluated the cost-effectiveness of treatments for women with polycystic ovary syndrome (PCOS) who ovulate on clomiphene citrate but do not conceive after six cycles. A decision-analytic framework was developed for six scenarios: (1) three cycles of IVF; (2) continuation of clomiphene citrate for six cycles, followed by three cycles of IVF in case of no birth; (3) six cycles of gonadotrophins and three cycles of IVF; (4) 12 cycles of gonadotrophins and three cycles of IVF; (5) continuation of clomiphene citrate for six cycles, six cycles of gonadotrophins and three cycles of IVF; (6) continuation of clomiphene citrate for six cycles, 12 cycles of gonadotrophins and three cycles of IVF. Two-year cumulative birth rates were 58%, 74%, 89%, 97%, 93% and 98% and costs per couple were € 9518, € 7530, € 9711, € 9764, € 7651 and € 7684 for scenarios 1-6, respectively. Scenario 2 was the lowest cost option. The extra cost for at least one live birth in scenario 5 was € 629 and in scenario 6 € 630. In these subjects, continuation of treatment for six cycles of clomiphene citrate, 6 or 12 cycles of gonadotrophins and IVF is potentially cost-effective. These results should be confirmed in a randomized clinical trial.

Long-term follow-up of laparoscopic electrocautery of the ovaries versus ovulation induction with recombinant FSH in clomiphene citrate-resistant women with polycystic ovary syndrome: an economic evaluation.

BACKGROUND: Laparoscopic electrocautery of the ovaries and ovulation induction with gonadotrophins are both second line treatments for women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Long-term follow-up after electrocautery versus ovulation induction with gonadotrophins has demonstrated at least comparable chances for a first live born child with a reduced need for ovulation induction or assisted reproduction treatment and increased chances for a second live born child. In this study, we report on the long-term economic consequences of both treatment modalities. METHODS: Between February 1998 and October 2001, we performed a multi-centre randomized controlled trial (RCT) comparing a strategy of laparoscopic electrocautery of the ovaries, followed by clomiphene citrate and gonadotrophins when anovulation persisted, and a strategy of ovulation induction with gonadotrophins in women with clomiphene citrate-resistant PCOS. Eight to twelve years after randomization we performed a follow-up study on reproductive outcome in these women and the fertility treatments they had needed including data on direct medical costs of pregnancy and delivery. Clinical data included number of treatment cycles, live births, miscarriages, ectopic pregnancies and multiple pregnancies. We calculated mean costs per woman after randomization until the first live birth. Confidence intervals (CIs) were estimated by bootstrapping. RESULTS: We obtained data for an economic analysis on 159 of the 168 randomized women (95%). In total, 71 of 83 women (86%) allocated to the electrocautery strategy and 69 of 85 women (81%) allocated to the gonadotrophin strategy had at least one live birth. Given the equivalence between the two treatment strategies in terms of a first live birth-the primary outcome measure-our analysis focused on the cost difference between the two strategies within a mean follow-up time of 8-12 years. The mean costs per first live birth after randomization were €11 176 (95% CI: €9689-€12 549) for the electrocautery group and €14 423 (95% CI: €12 239-€16 606) for the recombinant FSH group, resulting in significantly lower costs (P < 0.05) per first live birth for women allocated to the electrocautery group (mean difference €3247; 95% CI: €650-€5814). CONCLUSION: In women with clomiphene-resistant PCOS, laparoscopic electrocautery of the ovaries results in significantly lower costs per live birth than ovulation induction with gonadotrophins for an at least equal effectiveness.

Discussion: 'Novel clomiphene protocol in polycystic ovarian syndrome' by Hurst et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Hurst BS, Hickman JM, Matthews ML, Usadi RS, Marshburn PB. Novel clomiphene "stair-step" protocol reduces time to ovulation in women with polycystic ovarian syndrome. Am J Obstet Gynecol 2009;200:510.e1-510.e4.

A use-and-transformation model for evaluating public R&D: illustrations from polycystic ovarian syndrome (PCOS) research.

Evaluating federally funded research and development (R&D) presents unique challenges to both federal science agencies and evaluators. Often focusing only on outcome evaluative measures (such as productivity or economic value) can shortchange the true value of the federal investment. For example, program directors at the National Science Foundation (NSF) and National Institutes of Health (NIH) talk about the "value added" of the new interdisciplinary science centers that they have funded-and they hope to be able to capture how funding can generate increased capacity for new cutting-edge research in the future. The purpose of this paper is to present a use-and-transformation model for evaluating public R&D, which explicitly focuses on measuring capacity-based metrics for evaluation instead of outcome-based metrics. The theory for the model presented here explicitly uses the concept of a Knowledge Value Collective that was introduced by Bozeman and Rogers [Bozeman, B., & Rogers, J. D. (2002). A churn model of scientific knowledge value: Internet researchers as a knowledge value collective. Research Policy, 31(5), 769-794; Rogers, J. D., & Bozeman, B. (2001). "Knowledge value alliances": An alternative to the R&D project focus in evaluation. Science Technology & Human Values, 26(1), 23-55].

Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span.

CONTEXT: The polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of reproductive-aged women today, affecting approximately 6.6% of unselected reproductive-aged women (approximately 4 million women in the United States) (1990 National Institutes of Health criteria), and potentially represents a significant financial burden to our health care. OBJECTIVE: The objective of the study was to define, using current definitions and prevalence or incidence data, the minimal economic burden that PCOS in reproductive-aged women represents for the United States. DESIGN: The study design was a literature review. SETTING: The study was conducted at a tertiary care center. PATIENTS OR OTHER PARTICIPANTS: There were no patients or other participants. INTERVENTION(S): We performed a systematic review of the published medical literature to identify studies evaluating epidemiology of reproductive-age PCOS and its clinical consequences and costs. We tied general societal cost data for the different health consequences to reproductive-age PCOS costs, using prevalence data. MAIN OUTCOME MEASURE(S): The main measure in the study was total health care-related economic costs. RESULTS: We estimated the mean annual cost of the initial evaluation to be dollar 93 million (2.1% of total costs), that of hormonally treating menstrual dysfunction/abnormal uterine bleeding to be dollar 1.35 billion (31.0% of total), that of providing infertility care to be dollar 533 million (12.2% of total), that of PCOS-associated diabetes to be dollar 1.77 billion (40.5% of total), and that of treating hirsutism to be dollar 622 million (14.2% of total). CONCLUSIONS: The total cost of evaluating and providing care to reproductive-aged PCOS women in the United States is dollar 4.36 billion. Because the cost of the diagnostic evaluation accounted for a relatively minor part of the total costs (approximately 2%), more widespread and liberal screening for the disorder appears be a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequelae.

Ovulation induction with urinary FSH or recombinant FSH in polycystic ovary syndrome patients: a prospective randomized analysis of cost-effectiveness.

The aim of this prospective, randomized trial was to compare the clinical results and the cost-effectiveness of urinary FSH (uFSH) and recombinant FSH (rFSH) in ovarian stimulation for intrauterine insemination (IUI) cycles in polycystic ovary syndrome (PCOS) patients. One-hundred and seventy PCOS infertile patients undergoing IUI were enrolled, and protocols of ovarian stimulation with uFSH or rFSH were randomly assigned. The total number of cycles performed was 379 (182 and 197, respectively). The main outcome measures were the number of mature follicles, the days of stimulation, the number of ampoules and IU used per cycle, the biochemical/clinical pregnancy rates, the number of multiple pregnancies and the cost-effectiveness. No statistically significant differences were found in the follicular development, length of stimulation, pregnancy rates, delivery rates and multiple pregnancies between the two groups. In the uFSH group, the cost per cycle remained significantly lower (218.51 +/- 88.69 versus 312.22 +/- 118.12; P < 0.0001), even though a significantly higher number of IU of gonadotrophins were used (809.3 +/- 271.9 versus 589.1 +/- 244.7; P < 0.0001). The cost-effectiveness (i. e. within a group, the total cost of all cycles divided by no. of clinical pregnancies) was 1729.08 in the uFSH group and 3075.37 in the rFSH group. In conclusion, uFSH and rFSH demonstrated the same effectiveness in ovarian stimulation in IUI cycles in PCOS patients. The urinary preparation is more cost-effective due to the difference of its cost per IU.

An economic comparison of a laparoscopic electrocautery strategy and ovulation induction with recombinant FSH in women with clomiphene citrate-resistant polycystic ovary syndrome.

BACKGROUND: Recombinant FSH (rFSH) is the current standard treatment for ovulation induction in women with polycystic ovary syndrome (PCOS) that do not respond to clomiphene citrate. Ovulation induction with rFSH is known to be costly due to the necessity of daily injections and intensive monitoring. An alternative strategy, starting with electrocautery of the ovaries, may be a less costly option. METHODS: An economic evaluation was set up alongside a multicentre randomized clinical trial comparing laparoscopic electrocautery of the ovaries, followed by clomiphene citrate and rFSH when anovulation persisted, and treatment with rFSH in 168 women with clomiphene citrate-resistant PCOS. Data on resources used for treatment and productivity loss were collected prospectively up to an eventual ongoing pregnancy with a time horizon of 12 months. RESULTS: At 12 months the ongoing pregnancy rates were 67% for both the electrocautery strategy and rFSH treatment. Mean total costs per woman were 5308 euros for the electrocautery strategy and 5925 euros for treatment with rFSH, resulting in a mean difference of 617 (95% CI: -382 euros to 1614 euros). CONCLUSIONS: The total treatment costs up to an ongoing pregnancy are comparable for rFSH treatment and an alternative strategy starting with electrocautery. Due to a lower number of multiple pregnancies, the electrocautery strategy can be expected to result in lower total costs when costs of the delivery are included.

An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate resistant polycystic ovary syndrome.

BACKGROUND: Laparoscopic ovarian diathermy and gonadotrophin ovulation induction for women with clomiphene citrate resistant polycystic ovary syndrome have been shown to result in similar pregnancy rates, but their relative cost-effectiveness has not been evaluated. METHODS: A cost-minimization study was undertaken alongside a randomized controlled trial in women with anovulatory infertility secondary to clomiphene resistant polycystic ovary syndrome. Inclusion criteria were age less than 39 years, body mass index less than 35 kg/m(2), failure to ovulate with 150 mg of clomiphene citrate for 5 days in the early follicular phase, more than 12 months of infertility and no other causes of infertility. Laparoscopic ovarian diathermy was compared with three cycles of urinary or recombinant gonadotrophins. Direct and indirect costs were based on the results of a randomized trial. RESULTS: The cost of a live birth was one third lower in the group that underwent laparoscopic ovarian diathermy compared to those women who received gonadotrophins (19 640 New Zealand dollars and 29 836 New Zealand dollars, respectively). CONCLUSIONS: This economic evaluation shows that treating women with clomiphene-resistant polycystic ovarian syndrome with laparoscopic ovarian diathermy results in a significant reduction in both direct and indirect costs.

Surgical or medical treatment of polycystic ovary syndrome: a cost-benefit analysis.

With the availability of laparoscopic ovarian cautery, there has been a resurgence in interest in the surgical treatment of clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Comparison of ovulation and pregnancy rates has found no difference in success rates between ovarian cautery and gonadotropin ovulation induction for such women. We have therefore compared the cost of laparoscopic ovarian cautery with that of a typical cycle of gonadotropin ovulation induction, and also found that there is little difference. Because of the potential advantages of ovarian cautery, we recommend this surgery as the next line of treatment if clomiphene citrate fails to induce ovulation in PCOS patients, before gonadotropins are introduced.