An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate-resistant polycystic ovarian syndrome

Purpose of review Women with polycystic ovarian syndrome are typically anovulatory and require ovulation induction. Ovarian wedge resection was the first treatment for anovulation but was eventually abandoned because of the increased risk of postsurgical adhesions and as medical ovulation induction with clomiphene and gonadotrophins was introduced. However, with the advent of laparoscopy, there has been a return to surgical approaches. The potential advantages of laparoscopic surgery include avoidance of hyperstimulation and the lowered costs make ovarian surgery an attractive alternative to gonadotrophins. Recent findings Clinical trials in New Zealand and the Netherlands have compared costs of laparoscopic ovarian drilling with gonadotrophins. The total cost of treatment in the Netherlands study for the ovarian drilling group was Euro4664 and for the gonadotrophins group was Euro5418. Without the cost of monitoring and the diagnostic laparoscopy then the difference was Euro2110 in favour of ovarian drilling. It was estimated that the cost per term pregnancy would be Euro14489 for gonadotrophin and Euro11301 for ovarian drilling (22% lower). The higher rates of multiple pregnancy in the gonadotrophin group were considered to be responsible for the increased costs. In the New Zealand trial the costs of a live birth were one-third lower in the group that underwent laparoscopic ovarian diathermy compared with those women who received gonadotrophins (NZ$19640 and 29 836, respectively). Summary Treating women,with clomiphene-resistant-polycystic ovarian syndrome with laparoscopic ovarian diathermy results in reduced direct and indirect costs, The reduction in multiple pregnancies makes the alternative of surgery particularly attractive.