Document Detail

An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate-resistant polycystic ovarian syndrome.
MedLine Citation:
PMID:  15976539     Owner:  NLM     Status:  MEDLINE    
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 euro 4664 and for the gonadotrophins group was euro 5418. Without the cost of monitoring and the diagnostic laparoscopy then the difference was euro 2110 in favour of ovarian drilling. It was estimated that the cost per term pregnancy would be euro 14,489 for gonadotrophin and euro 11,301 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$19,640 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.
Cynthia M Farquhar
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Current opinion in obstetrics & gynecology     Volume:  17     ISSN:  1040-872X     ISO Abbreviation:  Curr. Opin. Obstet. Gynecol.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2006-08-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9007264     Medline TA:  Curr Opin Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  347-53     Citation Subset:  IM    
Department of Obstetrics & Gynaecology, University of Auckland, New Zealand.
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MeSH Terms
Cost-Benefit Analysis
Diathermy / economics*,  methods*
Drug Resistance
Gonadotropins / administration & dosage,  economics
Infertility / etiology,  therapy
Laparoscopy / economics*,  methods*
Ovulation Induction / economics
Polycystic Ovary Syndrome / complications,  therapy*
Pregnancy, Multiple / statistics & numerical data
Randomized Controlled Trials as Topic
Treatment Outcome
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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