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

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.