PCOS Estimated to Cost $8 Billion in Immediate, Long-term Health Issues

Polycystic ovary syndrome (PCOS)—the most common hormone disorder affecting women of reproductive age—costs more to diagnose and treat than previously known and carries the risk of long-term health effects but still suffers from a lack of clinical awareness and research funding, according to a new study.

According to an economic meta-analysis published in the Journal of Clinical Endocrinology & Metabolism, PCOS costs an estimated $8 billion to diagnose and treat nationwide in 2020. The estimate includes the direct costs of treating long-term metabolic health conditions related to PCOS, such as diabetes and stroke, as well as pregnancy-related costs. The economic burden of those conditions is an estimated $4.3 billion a year as of 2020.

The analysis expands upon an earlier study by the same authors, which did not include the costs of pregnancy complications and long-term morbidities. The more limited analysis found that diagnosing and treating common reproductive complications related to PCOS cost an estimated $3.7 billion annually as of 2020.

PCOS, a leading cause of infertility, is estimated to affect 5% to 20% of women of reproductive age and is marked by irregular menstrual periods, disruption of normal metabolism, and elevated testosterone levels.

Despite the prevalence of PCOS, many clinicians are unfamiliar with PCOS diagnostic criteria; over the past 30 years, 4 sets of criteria have been proposed. For their analysis, the researchers used the first set, developed by the National Institutes of Health (NIH) in 1990.

Women with PCOS are highly dissatisfied with their care, the authors noted, and research funding is lacking relative to its prevalence and cost.

“A clearer estimate of the economic burden of PCOS would be valuable to allow for a more accurate prioritization of the disorder as a public health interest,” the researchers said.

For the current study, the researchers conducted an initial electronic search and bibliography review, identifying 3146 studies and excluding 3082. Sixty-four further studies were reviewed in more detail and 35 additional ones were excluded, leaving 29 articles.

These articles included information about immediate health concerns, including gestational diabetes (GDM), gestational hypertension (gHTN), and preeclampsia, as well as long-term morbidities such as type 2 diabetes (T2D), myocardial infarction (MI), and stroke.

The excess cost of gHTN, GDM, and preeclampsia attributable to PCOS was $375 million in 2020, or just over 4% of the total economic burden of PCOS. gHTN accounted for just under half of that, preeclampsia one-third, and GDM 16%.

The excess cost of stroke attributable to PCOS accounted for 62% of the total cost of the long-term comorbidities. T2D accounted for the remaining 38%. The excess cost of T2D due to PCOS was estimated at $1.5 billion in 2020; the authors said this was lower that their previous estimate of $2.4 billion, likely because more studies adjust for differences in body mass index.

There was no significant different in the risk of MI with PCOS when matched with controls based on BMI.

The initial diagnostic process was less than 2% of the total cost burden, or about $139 million, “suggesting that ensuring quality diagnosis and evaluation for all patients is a cost-effective approach to ameliorating the complications and costs associated with PCOS,” the researchers noted.

The authors also said their estimates are likely conservative, since the NIH criteria they used is narrower than some of the others, and that they also included only direct costs, and not indirect costs or other diseases where women with PCOS may have greater risk.

“Although PCOS affects at least one in seven women and leads to over $8 billion in healthcare costs annually in the United States alone, it is frequently misunderstood or overlooked by clinicians and policymakers,” first author, Carrie Riestenberg, MD, of the University of California, Los Angeles, said in a statement. “With a better understanding of how to diagnose and treat this common condition effectively, we may be able to reduce the economic burden as well as the impact on women’s quality of life.”

Reference

Riestenberg C, Jagasia A, Markovic D, Buyalos RP, Azziz R. Health care-related economic burden of polycystic ovary syndrome in the United States: pregnancy-related and long-term health consequences. J Clin Endocrinol Metab. Published online ahead of print.