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

Wely, Madelon van

doi:10.1093/humrep/deh319

Cited by 46 publications

(23 citation statements)

References 19 publications

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“…In this regard, treatments used in PCOS patients by ameliorating the clinical aspects and preventing the long-term consequences of the disease could improve their QoL. Presently, few data (358,362,363) have evaluated the impact of specific treatment on QoL in PCOS patients.…”

Section: Quality Of Life Impairmentmentioning

confidence: 99%

Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review

et al. 2008

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Metformin is an insulin sensitizer widely used for the treatment of patients affected by type 2 diabetes mellitus. Because many women with polycystic ovary syndrome (PCOS) are insulin resistant, metformin was introduced in clinical practice to treat these patients also. Moreover, metformin's effect has other targets beside its insulin-sensitizing action. The present review was aimed at describing all evidence-based and potential uses of metformin in PCOS patients. In particular, we will analyze the uses of metformin not only for the treatment of all PCOS-related disturbances such as menstrual disorders, anovulatory infertility, increased abortion, or complicated pregnancy risk, hyperandrogenism, endometrial, metabolic and cardiovascular abnormalities, but also for the prevention of the syndrome. (Endocrine Reviews 30: 1-50, 2009)

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Section: Quality Of Life Impairmentmentioning

confidence: 99%

Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review

et al. 2008

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“…In women under treatment, the use of gonadotrophins was slightly more burdensome than LEO. Because of a lower number of multiple pregnancies, the LEO strategy can be expected to result in fewer obstetric complications and lower total costs if delivery costs are included in the economic analysis [19].…”

Section: Integrating Results and Making A Decisionmentioning

confidence: 99%

Evidence-based reproductive medicine in clinical practice: the case of clomiphene-resistant PCOS

Tetering

Dessel

Mol

2005

Eur Clinics Obstet Gynaecol

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Evidence-based medicine (EBM) tries to integrate best research evidence with clinical expertise and patient values. Clinicians can use this method to provide their counseled patients with the best available evidence. The aim of the present article is to demonstrate the application of EBM in everyday practice. We present a case of a woman with subfertility due to polycystic ovary syndrome (PCOS) who was not responding to treatment with clomiphene citrate. Herein a search of the literature is discussed, and a randomised clinical trial assessing the effectiveness of a strategy starting with laparoscopic electrocoagulation (LEO) and gonadotrophins is scrutinised with regard to internal validity. Studies on treatment should be appraised regarding method randomisation, concealment of allocation, blinding or masking, comparability of the groups, completeness of follow-up, analysis according to the intention-to-treat principle, equality of treatment of both groups, and adequate sample size. The study reports both treatments to be equally effective with respect to ongoing pregnancy, which is the primary outcome. A strategy starting with LEO seems to be more cost-effective and reduces the number of multiple pregnancies, which are arguments in favour of it. These arguments should be weighed against individual characteristics such as the risk of laparoscopic surgery and individual patient preferences.

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“…In contrast, van Wely et al [9] found a comparable societal cost up to an ongoing pregnancy between the two treatment strategies, and Farquhar et al [8] concluded that LOD was the least expensive option in CC-resistant PCOS patients. Both studies also used a societal approach.…”

Section: Discussionmentioning

confidence: 99%

“…These treatments have been proven to be effective but entail significant costs and possibly short- and long-term complications [4,5,6,7]. In 2004, two health-economic evaluations from a societal perspective comparing both treatment strategies were published [8,9]. Farquhar et al [8] concluded that LOD was the most cost-effective option, whereas van Wely et al [9] found that both treatments had a comparable cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

“…In 2004, two health-economic evaluations from a societal perspective comparing both treatment strategies were published [8,9]. Farquhar et al [8] concluded that LOD was the most cost-effective option, whereas van Wely et al [9] found that both treatments had a comparable cost-effectiveness. A health-economic evaluation by Nahuis et al [10], performed alongside a long-term follow-up study, concluded that LOD was the most cost-effective option from a public payer perspective.…”

Section: Introductionmentioning

confidence: 99%

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

Frène

Gerris²,

Weyers³

et al. 2015

Gynecol Obstet Invest

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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.

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

Cited by 46 publications

References 19 publications

Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review

Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review

Evidence-based reproductive medicine in clinical practice: the case of clomiphene-resistant PCOS

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

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