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Purpose <p>Which 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)?</p> Methods <p>Cost-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.</p> Results <p>Ongoing pregnancy rates (OPR) after the first, fourth, and sixth letrozole cycles were 16.1%, 41.6%, and 45.7%, with minimal gain beyond 4&#xa0;cycles. Deterministic analysis identified two cost-effective pathways: (a) 4&#xa0;cycles of letrozole followed by 2&#xa0;cycles of low-dose gonadotropins and COS, and (b) 4&#xa0;cycles of letrozole followed by 2&#xa0;cycles of low-dose gonadotropins, 1&#xa0;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.</p> Conclusion <p>This 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.</p>

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Cost-effectiveness of infertility treatment pathways in PCOS: where does oocyte in-vitro maturation fit?

  • 期刊论文

  • 发表日期：

    2026年6月23日

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  • Linde Mostinckx,
  • Neli Hofer,
  • Max Lelie,
  • Shari Mackens,
  • Ingrid Segers,
  • Katrien Beeckman,
  • Michel De Vos

摘要

Purpose

Which 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)?

Methods

Cost-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.

Results

Ongoing 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.

Conclusion

This 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.