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.
van Wely
M
M
Center for Reproductive Medicine, Department of Obstetrics and Gynaecology (H4-205), Academic Medical Center, University of Amsterdam, P.O.Box 22700, 1100 DE Amsterdam, The Netherlands. m.vanwely@amc.uva.nl
Bayram
N
N
van der Veen
F
F
Bossuyt
P M M
PM
D000328:Adult; D002996:Clomiphene; D017046:Cost Savings; D004351:Drug Resistance; D004564:Electrocoagulation / Q000191:economics*; D005260:Female; D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D010062:Ovulation Induction / Q000191:economics* / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000191:economics*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use
D005300:Fertility Agents, Female; D011994:Recombinant Proteins; D002996:Clomiphene; D005640:Follicle Stimulating Hormone