ArticleJournal of assisted reproduction and genetics2026
Cost-effectiveness of infertility treatment pathways in PCOS: where does oocyte in-vitro maturation fit?
Article in Journal of assisted reproduction and genetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeWhich infertility treatment pathway is most cost-effective for women with polycystic ovary syndrome (PCOS)-related infertility in centres with expertise in oocyte in vitro maturation (IVM)?
methodsCost-effectiveness analysis of treatment pathways for PCOS-related infertility using a Markov decision-analytic model. Real-life data from 517 anovulatory PCOS patients treated between January 2018 and January 2023 at a Belgian tertiary infertility clinic informed model parameters and defined the treatment-as-usual (TAU) strategy. Five pathways including incremental cycles of letrozole, low-dose gonadotropins, assisted reproductive technology (ART) after conventional ovarian stimulation (COS) or IVM were modelled and compared to TAU. Patients transitioned between treatment cycles, resulting in ongoing pregnancy or drop-out over a 24-month horizon. Costs were assessed from healthcare and societal perspectives, including direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were calculated, with sensitivity analyses performed.
resultsOngoing pregnancy rates (OPR) after the first, fourth, and sixth letrozole cycles were 16.1%, 41.6%, and 45.7%, with minimal gain beyond 4 cycles. Deterministic analysis identified two cost-effective pathways: (a) 4 cycles of letrozole followed by 2 cycles of low-dose gonadotropins and COS, and (b) 4 cycles of letrozole followed by 2 cycles of low-dose gonadotropins, 1 cycle of IVM, and COS, with ICERs of -€8174 and -€10,805 from the healthcare perspective, and -€11,494 and -€14,083 from the societal perspective, respectively. Incorporating IVM as second-line would require a 25.7% relative OPR increase from IVM, to become the most cost-effective pathway. Probabilistic sensitivity analyses confirmed robustness.
conclusionThis model highlights the role of IVM as a valuable component of PCOS infertility treatment in centres of expertise, with potential for greater impact as culture systems advance.
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