Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate

Lobke M. Moolenaar, Marleen J. Nahuis, Peter G. Hompes, Fulco Van Der Veen, Ben Willem J Mol

Research output: Contribution to journalArticle

3 Citations (Scopus)

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. The aim of this study was to evaluate the cost-effectiveness of scenarios for women with PCOS who ovulate on clomiphene citrate but do not conceive after six cycles. A decision-analytic framework was developed. We evaluated six treatment scenarios. This study showed that in women with PCOS and clomiphene citrate failure after six cycles, continuation of treatment with six cycles of clomiphene citrate followed by 6-12 cycles of gonadotrophins and IVF is potentially cost-effective. These results should be confirmed in a randomized clinical trial.

LanguageEnglish
Pages606-613
Number of pages8
JournalReproductive BioMedicine Online
Volume28
Issue number5
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • PCOS
  • clomifene citrate
  • cost-effectiveness
  • failure
  • gonadotropins

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Developmental Biology

Cite this

Moolenaar, Lobke M. ; Nahuis, Marleen J. ; Hompes, Peter G. ; Van Der Veen, Fulco ; Mol, Ben Willem J. / Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate. In: Reproductive BioMedicine Online. 2014 ; Vol. 28, No. 5. pp. 606-613.
@article{03bc90c4f2974b608d8acce1d5a9408e,
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. The aim of this study was to evaluate the cost-effectiveness of scenarios for women with PCOS who ovulate on clomiphene citrate but do not conceive after six cycles. A decision-analytic framework was developed. We evaluated six treatment scenarios. This study showed that in women with PCOS and clomiphene citrate failure after six cycles, continuation of treatment with six cycles of clomiphene citrate followed by 6-12 cycles of gonadotrophins and IVF is potentially cost-effective. These results should be confirmed in a randomized clinical trial.",
keywords = "PCOS, clomifene citrate, cost-effectiveness, failure, gonadotropins",
author = "Moolenaar, {Lobke M.} and Nahuis, {Marleen J.} and Hompes, {Peter G.} and {Van Der Veen}, Fulco and Mol, {Ben Willem J}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.rbmo.2014.01.014",
language = "English",
volume = "28",
pages = "606--613",
journal = "Reproductive BioMedicine Online",
issn = "1472-6483",
publisher = "Elsevier",
number = "5",

}

Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate. / Moolenaar, Lobke M.; Nahuis, Marleen J.; Hompes, Peter G.; Van Der Veen, Fulco; Mol, Ben Willem J.

In: Reproductive BioMedicine Online, Vol. 28, No. 5, 01.01.2014, p. 606-613.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate

AU - Moolenaar, Lobke M.

AU - Nahuis, Marleen J.

AU - Hompes, Peter G.

AU - Van Der Veen, Fulco

AU - Mol, Ben Willem J

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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. The aim of this study was to evaluate the cost-effectiveness of scenarios for women with PCOS who ovulate on clomiphene citrate but do not conceive after six cycles. A decision-analytic framework was developed. We evaluated six treatment scenarios. This study showed that in women with PCOS and clomiphene citrate failure after six cycles, continuation of treatment with six cycles of clomiphene citrate followed by 6-12 cycles of gonadotrophins and IVF is potentially cost-effective. These results should be confirmed in a randomized clinical trial.

AB - 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. The aim of this study was to evaluate the cost-effectiveness of scenarios for women with PCOS who ovulate on clomiphene citrate but do not conceive after six cycles. A decision-analytic framework was developed. We evaluated six treatment scenarios. This study showed that in women with PCOS and clomiphene citrate failure after six cycles, continuation of treatment with six cycles of clomiphene citrate followed by 6-12 cycles of gonadotrophins and IVF is potentially cost-effective. These results should be confirmed in a randomized clinical trial.

KW - PCOS

KW - clomifene citrate

KW - cost-effectiveness

KW - failure

KW - gonadotropins

UR - http://www.scopus.com/inward/record.url?scp=84899919208&partnerID=8YFLogxK

U2 - 10.1016/j.rbmo.2014.01.014

DO - 10.1016/j.rbmo.2014.01.014

M3 - Article

VL - 28

SP - 606

EP - 613

JO - Reproductive BioMedicine Online

T2 - Reproductive BioMedicine Online

JF - Reproductive BioMedicine Online

SN - 1472-6483

IS - 5

ER -