P-671 Cost-effectiveness of different infertility treatment pathways in infertile anovulatory women with PCOS: does In Vitro Maturation (IVM) of oocytes offer added value? Article Swipe
L Mostinckx
,
Nora Hofer
,
Max Lelie
,
Shari Mackens
,
Ingrid Segers
,
Katrien Beeckman
,
Michel De Vos
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1093/humrep/deaf097.977
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1093/humrep/deaf097.977
Study question Is it cost-effective to incorporate IVM in the infertility treatment algorithm for infertile anovulatory women with PCOS? Summary answer While IVM is associated with a lower cost per cycle, increased pregnancy rates are required to make IVM cost-effective compared to other strategies. What is known already A treatment algorithm has been developed for infertile anovulatory women with PCOS, based on best evidence regarding the effectiveness of different treatment options. Ovulation induction using letrozole is the preferred first-line pharmacological infertility therapy; gonadotropin ovulation induction and IVF have been recommended for women who are not pregnant after letrozole, and IVM can be considered in centres of expertise. However, studies investigating cost-effectiveness of treatment pathways are scarse. In view of the high prevalence of PCOS, the impact on reproductive health, and the moderate-to-low quality of available evidence, fine-tuning of the treatment algorithm of PCOS-related infertility is paramount. Study design, size, duration We performed a cost-effectiveness analysis, using a Markov decision model, evaluating different infertility treatment pathways for patients who failed to conceive after ovulation induction using letrozole. Treatment-As-Usual (TAU) data from 517 nulliparous anovulatory PCOS patients treated in a Belgian tertiary centre between January 2018 and January 2023 were used to build the base for the Markov model. Estimated costs included direct medical costs and direct non-medical costs (travel expenses) based on the 2024 Belgian prices. Participants/materials, setting, methods Descriptive statistics were used to analyse ongoing pregnancy rate (OPR), cost (€) per cycle, time-to-pregnancy (TTP) and number of hospital visits per treatment type. Cost-effectiveness using OPR as primary outcome was calculated for different pathways: (A) four letrozole cycles -> IVM -> IVF; (B) four letrozole cycles -> two gonadotropin cycles -> IVM -> IVF; (C) four letrozole cycles -> IVF; (D) four letrozole cycles -> two gonadotropin cycles -> IVF. Main results and the role of chance On average, patients were 29.0±3.7years old, with AMH 8.5±5.9ng/mL and BMI 25.7±5.3kg/m², and were trying to conceive for 1.4±1.2years. Ongoing pregnancy rate after the first, fourth and sixth letrozole cycle was 16.1%, 41.6% and 45.7%, respectively. When compared to letrozole (4.5±1.9visits), gonadotropins (5.5±1.7visits) and IVF (4.7±1.0visits), fewer hospital visits were required for IVM cycles (2.5±0.8 visits). Time-To-Pregnancy as expressed by the interval between the start of the cycle and a positive hCG test resulting in ongoing pregnancy was shorter for patients undergoing gonadotropin ovulation-induction (82.8days), compared to IVM (137.3days) and IVF (159.4days). Both direct medical and direct non-medical costs were lower for IVM (€4223 + €70) compared to IVF (€4644 + €133). After preliminary analysis of the different pathways, pathway C appeared to be the most cost-effective scenario compared to Treatment-As-Usual (TAU) for OPR, with an incremental cost-effectiveness ratio (ICER) per ongoing pregnancy of €-1,391 (from a healthcare perspective) and €-2,142 (from a societal perspective). For IVM to become the most cost-effective second-line approach overall (pathway A), OPR for IVM should increase by ∼26.4% (absolute increase of 13.0%). These results are subject to change pending more updated statistics. Limitations, reasons for caution Although the cost-effectiveness analysis included direct medical costs and travel expenses, the cost of loss of working hours for patients was not included. Second, patients in Belgium benefit from broad health care insurance coverage; hence, standardized cost should be included in the model for generalizability of results. Wider implications of the findings The development of optimal models of care and strategies for shared decision making has been identified as a research priority in PCOS. The analysis of burden and geospatial cost-effectiveness data of different pathways of infertility treatment is instrumental to guide future research and to develop patient-tailored treatment algorithms. Trial registration number No
Related Topics
Concepts
Infertility
Anovulation
Gynecology
In vitro fertilisation
Andrology
Medicine
Biology
Pregnancy
Polycystic ovary
Endocrinology
Diabetes mellitus
Insulin resistance
Genetics
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/humrep/deaf097.977
- https://academic.oup.com/humrep/article-pdf/40/Supplement_1/deaf097.977/63540361/deaf097.977.pdf
- OA Status
- bronze
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4411749188
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4411749188Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/humrep/deaf097.977Digital Object Identifier
- Title
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P-671 Cost-effectiveness of different infertility treatment pathways in infertile anovulatory women with PCOS: does In Vitro Maturation (IVM) of oocytes offer added value?Work title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-06-01Full publication date if available
- Authors
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L Mostinckx, Nora Hofer, Max Lelie, Shari Mackens, Ingrid Segers, Katrien Beeckman, Michel De VosList of authors in order
- Landing page
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https://doi.org/10.1093/humrep/deaf097.977Publisher landing page
- PDF URL
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https://academic.oup.com/humrep/article-pdf/40/Supplement_1/deaf097.977/63540361/deaf097.977.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/humrep/article-pdf/40/Supplement_1/deaf097.977/63540361/deaf097.977.pdfDirect OA link when available
- Concepts
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Infertility, Anovulation, Gynecology, In vitro fertilisation, Andrology, Medicine, Biology, Pregnancy, Polycystic ovary, Endocrinology, Diabetes mellitus, Insulin resistance, GeneticsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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10Other works algorithmically related by OpenAlex
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