Exploring the Economic and Clinical Landscape of Managing Polyendocrine Metabolic Ovarian Syndrome: A Systematic Review, Mixed-Methods Survey, and Preliminary Cost Analysis

Abstract

Background:
Polyendocrine metabolic ovarian syndrome (PMOS) is a prevalent, multifaceted condition that affects the reproductive, endocrine, and metabolic systems. The primary manifestations of the condition are hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Due to the heterogeneous nature of PMOS, and unstandardised diagnostic criteria, the prevalence of the condition remains underestimated. Moreover, the limited understanding and acknowledgement of the condition results in apparent challenges pertaining to the diagnosis, management, and subsequently, the quality of life and wellbeing for those experiencing PMOS. Therefore, the research outlined within this thesis sought to explore PMOS across the reproductive life course, predominantly focusing on the management of the characteristic features of the condition and the associated costs, in addition to the barriers encountered and lived experiences associated with managing PMOS. 

Methods:
A mixed methods approach was utilised, comprising three separate analyses, a systematic review, an online survey, and a cost analysis. The systematic review was conducted to identify economic evaluations and cost analyses of interventions utilised for managing the primary manifestations of PMOS. The online survey was disseminated to individuals with PMOS, to explore the barriers experienced when accessing healthcare, the allocation and uptake of management strategies prescribed for specific clinical features and phenotypes, and the productivity impact of PMOS. The cost analysis was performed using the survey data, to primarily determine the phenotypic costs associated with the management of PMOS, in addition to the cost of productivity loss, and diagnostic pathways.

Results:
A total of 4,825 studies were identified from the systematic review, of which 13 evaluations were included: ten full economic evaluations, and three partial cost analyses. The majority of evidence pertained to PMOS-induced fertility management, as opposed to strategies implemented for the management of the primary characteristic features of the condition. Survey findings (n = 44) established the majority of respondents were living with unmanaged PMOS and associated symptoms, due to a multitude of interconnecting healthcare and personal barriers. Of those with hyperandrogenism, less than 50% were managing their cutaneous manifestations. Similarly, of those with ovulatory dysfunction, 59% were not currently prescribed medication to manage irregular menses. Health service resource use was estimated to be higher amongst those with phenotype A, compared with those experiencing other phenotypes. The annual average direct NHS cost burden was estimated to be £206 per treated person. Phenotype C was found to incur the highest estimated average annual productivity loss per person of £5,660, whilst phenotype A was found to incur the lowest per person productivity cost of £464.

Conclusion:
The systematic review indicated a scarcity of clinical and economic evidence relating to the management of PMOS. Furthermore, it was established that women’s healthcare remains marginalised and fragmented; therefore, further measures should be implemented to improve healthcare-related-and patient-related outcomes for those with PMOS. Additional research is necessary to not only increase the exposure of health economics within PMOS research, but to also aid with the efficient distribution of resources and to combat the apparent unmet clinical needs for those with PMOS.

Date of Award	9 Sept 2026
Original language	English
Awarding Institution	Bangor University
Supervisor	Nathan Bray (Supervisor) & Ceryl Davies (Supervisor)