title: 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.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, H4-205, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ The Netherlands. m.nahuis@vumc.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Nahuis
authors.forename: E
authors.initials: E
authors.lastname: Oude Lohuis
authors.forename: N
authors.initials: N
authors.lastname: Kose
authors.forename: N
authors.initials: N
authors.lastname: Bayram
authors.forename: P
authors.initials: P
authors.lastname: Hompes
authors.forename: G J E
authors.initials: GJ
authors.lastname: Oosterhuis
authors.forename: E M
authors.initials: EM
authors.lastname: Kaaijk
authors.forename: B J
authors.initials: BJ
authors.lastname: Cohlen
authors.forename: P P M
authors.initials: PP
authors.lastname: Bossuyt
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: M
authors.initials: M
authors.lastname: van Wely
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004564:Electrocoagulation / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D050498:Live Birth; D009426:Netherlands; D010053:Ovary / Q000601:surgery; D010062:Ovulation Induction / Q000191:economics* / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency
chemical_list: D002996:Clomiphene