title: Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: L.M.Moolenaar@amc.uva.nl.
authors.forename: Lobke M
authors.initials: LM
authors.lastname: Moolenaar
authors.affiliation: Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marleen J
authors.initials: MJ
authors.lastname: Nahuis
authors.affiliation: Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Hompes
authors.affiliation: Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005300:Fertility Agents, Female / Q000191:economics / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000191:economics; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D010062:Ovulation Induction / Q000191:economics*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000191:economics* / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D061685:Time-to-Pregnancy; D017211:Treatment Failure
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: PCOS; clomifene citrate; cost-effectiveness; failure; gonadotropins