PDB81 A COST-EFFECTIVENESS ANALYSIS OF POLYCYSTIC OVARY SYNDROME (PCOS) MANAGEMENT USING METFORMIN TO REDUCE THE RISK OF GESTATIONAL DIABETES MELLITUS (GDM) IN PREGNANT WOMEN

Abstract

This study estimated the cost-effectiveness of metformin use to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health care payer perspective. Decision tree model was developed from the US health care payer perspective to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women who already diagnosed with PCOS. For average age group ±30 years old, two strategies were compared: using metformin or a no medications strategy to manage PCOS during pregnancy. Normal pregnancies without developing GDM, costs, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed over the three trimesters of pregnancy. Evidence from randomized clinical trials, epidemiological studies, and other published literature were used to assess disease progression and its associated healthcare costs. Sensitivity analyses that varied key model parameters were conducted. Management of PCOS with metformin was less costly with lowest ACER ($US 669.78 per normal pregnancy without GDM) while “no intervention” strategy was associated with highest ACER ($US 1,990.86 per normal pregnancy without GDM). Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $US 7,593,372.97 and an average effect gain of 2271 of normal pregnancies without GDM among 10,000 pregnant women with PCOS. Sensitivity analyses determined that the results are robust. Using metformin to manage PCOS is a dominant strategy as compared with no medications strategy to reduce GDM risk and its associated complications and costs for pregnant women with PCOS if they do not have contraindications.