BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common hormone disorder affecting about one in seven reproductive-aged women worldwide and approximately 6 million women in the United States (U.S.). PCOS can be a significant burden to those affected and is associated with an increased prevalence of mental health (MH) disorders such as depression, anxiety, eating disorders, and postpartum depression. We undertook this study to determine the excess economic burden associated with MH disorders in women with PCOS, in order to allow for a more accurate prioritization of the disorder as a public health priority. <br />METHODS: Followed PRISMA reporting guidelines for systematic review, we searched 60 PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021, for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer reviewed. As anxiety, depression, eating disorders, and postpartum depression were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model to compute pooled estimates of prevalence ratios (PR) for the associations between PCOS and these MH disorders, and then calculated the excess direct costs of related to these disorders in U.S. dollars (USD) for women suffering from PCOS in the U.S. alone. The quality of selected studies was assessed using the Newcastle Ottawa Scale. <br />RESULTS: We screened 78 articles by title/abstract, assessed 43 articles in full-text, and included 25 articles. Pooled PRs were 1.42 (95% CI: 1.32-1.52) for anxiety, 1.65 (95% CI: 1.44- 1.89;) for depression, 1.48 (95% CI: PR: 1.06-2.05) for eating disorders, and 1.20 (95% CI: 0.96-1.50) for postpartum depression, for PCOS relative to controls. In the U.S, the additional direct healthcare costs associated with anxiety, depression and eating disorders in PCOS were estimated to be $1.939 billion/yr., 1.678 billion/yr., and $0.644 billion/yr. in 2021 USD, respectively. Postpartum depression was excluded from the cost analyses due to the non-significant meta-analysis result. Taken together, the additional direct healthcare costs associated with anxiety, depression and eating disorders in PCOS was estimated to be $4.261 billion/yr. in 2021 USD. <br />CONCLUSIONS: Overall, the direct healthcare annual costs for the most common MH disorders in PCOS, namely anxiety, depression, and eating disorders exceeds $4 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $15 billion yearly, considering the costs of PCOS diagnosis, and cost related to PCOS-associated MH, reproductive, vascular, and metabolic disorders. As PCOS has much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. <br />FUNDING: The study was supported, in part, by PCOS Challenge: The National Polycystic Ovary Syndrome Association and by the Foundation for Research and Education Excellence
BACKGROUND: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine abnormality of reproductive-aged women today, affecting one in seven reproductive-aged women worldwide, and represents a significant financial burden to our health care. Women with PCOS have an increased risk for developing mental health (MH) disorders, in part due to biochemical changes, constant concerns regarding physical appearance, and social stigma from hirsutism, obesity, and infertility. OBJECTIVE: To determine the excess economic burden associated with MH disorders in women with PCOS. METHOD: Followed PRISMA reporting guidelines for systematic review, we searched PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021 for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer-reviewed. As anxiety, depression, and eating disorders were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model (DerSimonian and Laird 1986) to compute pooled estimates of odds ratios (OR) for the associations between PCOS and anxiety, depression, and eating disorders. Study-specific and overall estimates using the log-odds scale were presented using forest plots. Between-study heterogeneity was evaluated using the I2 statistic. We then calculated the excess direct costs of these MH in U.S. dollars (USD) for women suffering from PCOS. RESULT: We screened 72 articles by title/abstract, assessed 37 articles in full-text, and included 24 articles. Pooled ORs were 1.65 (95% CI: 1.15-2.38) for anxiety, 2.20 (95% CI: 1.69-2.86) for depression, and 2.53 (95% CI: 1.14-2.07) for eating disorders, for PCOS relative to controls. In the U.S., the additional direct healthcare costs associated with MH disorders in PCOS were estimated to be $3.075 billion/yr., $2.280 billion/yr., and $0.714 billion/yr. in 2021 USD for depression, anxiety, and eating disorders, respectively. Taken together, the additional direct healthcare costs associated with these MH disorders in PCOS was estimated to be $6.069 billion/yr. in 2021 USD. CONCLUSION: This work is the first to estimate the excess direct healthcare costs of MH disorders associated with PCOS. Overall, the direct healthcare costs for the most common MH disorders in PCOS, namely depression, anxiety, and eating disorders, exceeded $6 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $14 billion yearly, considering the costs of diagnosis, and MH, reproductive, vascular, and metabolic disorders (but not indirect and intangible costs). As PCOS is a global disorder with much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. Presentation: Saturday, June 11, 2022 1:36 p.m. - 1:41 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
Background: Polycystic ovary syndrome (PCOS) is the most common hormone disorder affecting about one in seven reproductive-aged women worldwide and approximately 6 million women in the United States (U.S.). PCOS can be a significant burden to those affected and is associated with an increased prevalence of mental health (MH) disorders such as depression, anxiety, eating disorders, and postpartum depression. We undertook this study to determine the excess economic burden associated with MH disorders in women with PCOS in order to allow for a more accurate prioritization of the disorder as a public health priority. Methods: Following PRISMA reporting guidelines for systematic review, we searched PubMed, Web of Science, EBSCO, Medline, Scopus, and PsycINFO through July 16, 2021, for studies on MH disorders in PCOS. Excluded were studies not in humans, without controls, without original data, or not peer reviewed. As anxiety, depression, eating disorders, and postpartum depression were by far the most common MH disorders assessed by the studies, we performed our meta-analysis on these disorders. Meta-analyses were performed using the DerSimonian-Laird random-effects model to compute pooled estimates of prevalence ratios (PR) for the associations between PCOS and these MH disorders and then calculated the excess direct costs related to these disorders in U.S. dollars (USD) for women suffering from PCOS in the U.S. alone. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. Results: We screened 78 articles by title/abstract, assessed 43 articles in full-text, and included 25 articles. Pooled PRs were 1.42 (95% CI: 1.32-1.52) for anxiety, 1.65 (95% CI: 1.44-1.89;) for depression, 1.48 (95% CI: PR: 1.06-2.05) for eating disorders, and 1.20 (95% CI: 0.96-1.50) for postpartum depression, for PCOS relative to controls. In the U.S., the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $1.939 billion/yr., 1.678 billion/yr., and $0.644 billion/yr. in 2021 USD, respectively. Postpartum depression was excluded from the cost analyses due to the non-significant meta-analysis result. Taken together, the additional direct healthcare costs associated with anxiety, depression, and eating disorders in PCOS were estimated to be $4.261 billion/yr. in 2021 USD. Conclusions: Overall, the direct healthcare annual costs for the most common MH disorders in PCOS, namely anxiety, depression, and eating disorders, exceeds $4 billion in 2021 USD for the U.S. population alone. Taken together with our prior work, these data suggest that the healthcare-related economic burden of PCOS exceeds $15 billion yearly, considering the costs of PCOS diagnosis, and costs related to PCOS-associated MH, reproductive, vascular, and metabolic disorders. As PCOS has much the same prevalence across the world, the excess economic burden attributable to PCOS globally is enormous, mandating that the scientific and policy community increase its focus on this important disorder. Funding: The study was supported, in part, by PCOS Challenge: The National Polycystic Ovary Syndrome Association and by the Foundation for Research and Education Excellence.
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