We calculated the health care-related economic burden in PCOS based on the above prevalences of disease (64). We restricted the calculation to the United States only, although we recognize that PCOS is an international disorder. However, we should note that our estimation is highly conservative because we did not include a number of costs for which we did not have accurate and present-day prevalence and monetary estimates (Table 1). We did include the costs of the initial evaluation, detailed in Table 2.
The overall costs associated with the treatment and, if appropriate, the diagnosis of the various morbidities evident in the premenopausal women with PCOS are outlined in Table 3. This conservative estimate of the health care-related economic burden of premenopausal women with PCOS exceeded $4 billion annually in the United States alone. Approximately 40% of the burden is a result of the increased prevalence of diabetes associated with PCOS; 30% arises from the treatment of the associated menstrual dysfunction/AUB, 14% from the treatment of hirsutism, and 12% the provision of infertility services. Notably, the costs of the diagnostic evaluation of all patients accounted for a relatively small portion of the calculated economic burden, about 2%. The calculated economic burden of patients with PCOS during their reproductive years is about threefold that of hepatitis C ($1 billion in 1998) (65) and about one-third that of morbid obesity ($11 billion in 2000) (66).
According to factors not included in our model (see Table 1), it is highly likely that we are underestimating the economic burden of PCOS. Alternatively, a few factors in our analysis may have resulted in an overestimation of the economic burden. Most importantly, our calculations were based on the assumption that all patients with PCOS will seek and be willing to undergo the required evaluations and treatments. Second, the prevalence of menstrual dysfunction appears to decrease with in the later reproductive years (13).
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