Cost-Effectiveness of Interventions Related to the Treatment of Women With Polycystic Ovary Syndrome: A Scoping Review

Emily Joy Callander,1,2 Yanan Hu,1 Alayna Carrandi,2 Chau Thien Tay,2 Aya Mousa,2 Helena Teede2 1School of Public Health, University of Technology Sydney, Sydney, NSW, Australia; 2Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, AustraliaCorrespondence: Emily Joy Callander, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, 2007, Australia, Email [email protected]: Polycystic ovary syndrome (PCOS) affects up to one-in-five reproductive-aged women and its global healthcare-related economic burden is substantial. The aim of this review was to summarise evidence of the cost-effectiveness of interventions related to the treatment of women with PCOS.Evidence Acquisition: Six academic databases were systematically searched for relevant records. Cost data were extracted, and an interpretation statement was provided for each study based upon the cost difference or incremental cost-effectiveness ratio, and its statistical significance.Evidence Synthesis: The search yielded 10 relevant studies. Only one study was conducted in a low- and middle-income country (LMIC), China. Nine studies focused on infertility treatment, and one study related to pregnancy care. There remains uncertainty regarding cost-effectiveness of the following infertility treatments: In vitro fertilisation (IVF) cycles compared to ovulation induction (OI) cycles in women with clomiphene citrate (CC) resistant PCOS; and urinary follicle stimulating hormone compared to recombinant follicle stimulating hormone for OI. There are likely cost savings associated with laparoscopic ovarian drilling compared to OI with gonadotropins in women with CC-resistant PCOS, as well as with artificial cycle-frozen embryo transfer (AC-FET) without gonadotropin releasing hormone agonist (GnRH-a) pre-treatment compared to AC-FET with GnRH-a pre-treatment in women with PCOS. Treatment with metformin was lower cost and more effective compared to no treatment for achieving normal glucose regulation without developing gestational diabetes mellitus.Conclusion: The high proportion of fertility-related treatment studies reflects reproductive features often being the best-recognised feature of PCOS. However, limited evidence is available from LMICs. Further economic evidence is needed regarding PCOS treatments, particularly lifestyle interventions treating outcomes other than infertility.Keywords: cost-effectiveness analysis, health expenditure, polycystic ovary syndrome, infertility, pregnancy