OBJECTIVES: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder amongst women. Diagnosis is based on the Rotterdam criteria, which requires at least two of the following criteria to be met: oligo-anovulation, clinical/biochemical hyperandrogenism and polycystic ovarian morphology (PCOM). PCOM detection has previously relied on transvaginal ultrasound (TVUS), which is limited by diagnostic performance, accessibility and inter- and intra-operator variability. Anti-Müllerian hormone (AMH) testing is a new recommended alternative. This health economic study assessed the impact of using the Elecsys^® AMH Plus immunoassay (Roche Diagnostics International Ltd) to detect PCOM for the diagnosis of PCOS in the United Kingdom (UK).

METHODS: A decision tree model was developed to estimate health and cost outcomes when replacing TVUS with the Elecsys AMH Plus immunoassay to assess women aged 25–45 years with signs and symptoms of PCOS in different diagnostic pathways. The model focused on the UK National Health Service (NHS) assuming in the reference case that the 2023 International Evidence-Based Guidelines were followed. Model parameters were obtained from published literature, unit cost registries and expert opinions. Several scenario and sensitivity analyses were performed to assess the impact of uncertainty on results and identify its drivers.

RESULTS: In the reference analysis, total costs per year for diagnosing PCOS were £19,984,053 with TVUS and £19,763,518 with the Elecsys AMH Plus immunoassay; a saving of £220,535 per year (£17 per diagnosis). Across all scenario analyses, the Elecsys AMH Plus immunoassay resulted in lower costs for the NHS compared with TVUS pathway. Sensitivity of TVUS, Elecsys AMH Plus immunoassay unit cost and percentage risk reduction (efficacy of lifestyle interventions) were the main drivers of the model in deterministic sensitivity analysis.

CONCLUSIONS: This analysis identified that the NHS could benefit from substantial cost savings by utilising the Elecsys AMH Plus immunoassay for assessing women with signs and symptoms of PCOS.