Department of Statistical Science, University College London, 1-19 Torrington Place, London, UK.
Institute for Women's Health, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
Hum Reprod. 2018 Jul 1;33(7):1299-1306. doi: 10.1093/humrep/dey093.
What is the incidence/prevalence of type 2 diabetes in women with polycystic ovary syndrome (PCOS) and the economic burden associated with PCOS in the UK?
The incidence and prevalence of type 2 diabetes in women with PCOS are 3-33 per 1000 person years and 26.5%, respectively, with an associated annual healthcare burden of at least £237 million in the UK.
Although observational studies have been designed to assess the incidence of diabetes in women with PCOS, these have been open to criticism because of short periods of follow-up, small sample sizes or invalidated diagnosis of PCOS. Only one study has estimated the healthcare-related economic burden of PCOS, reporting a cost of $4.36 billion per year in the USA.
STUDY DESIGN, SIZE, DURATION: This was a modelling study using individual patient data from a UK primary care database between 2004 and 2014 and aggregate data from the literature to obtain conversion rates through disease progression of PCOS. A simulation approach was applied to model the population dynamics of PCOS over a follow-up period of 25 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 14 135 women with PCOS or symptoms indicative of PCOS were selected from the primary care database to estimate the incidence of confirmed diagnosis of PCOS and diagnosis of type 2 diabetes. A 'virtual' cohort including the entire PCOS population (size estimated from the UK census data) was simulated to model the population dynamics of PCOS. The economic and utility analyses were further conducted from a healthcare perspective.
The peak conversion rate from possible to diagnosed PCOS was 121 per 1000 person-year (PY). The maximal incidence of type 2 diabetes was 33 per 1000 PY. The estimated prevalence of diabetes in the PCOS population was 26.5% (95% interval: 25.4-27.8%) during a 25-year follow-up. The annual healthcare burden of PCOS based on our conservative estimate is at least £237 million for the follow-up period examined.
LIMITATIONS, REASONS FOR CAUTION: Due to lack of data, a full economic evaluation including healthcare costs of all the comorbidities associated with PCOS was not possible. Simplification of the real-world situation represented by the model may be a concern.
This study suggests that a large number of women with symptoms indicative of PCOS never receive a definitive diagnosis yet can suffer from a rapid conversion to diabetes. This significantly reduces the quality of life for individual patients and incurs high costs for healthcare providers. As the risk of diabetes in women with PCOS is similar to that seen in populations at high risks of diabetes, it is possible that including them in national screening programmes may be cost effective.
STUDY FUNDING/COMPETING INTEREST(S): There was no funding for the current study. There are no conflicts of interest.
Not applicable.
多囊卵巢综合征（PCOS）女性中 2 型糖尿病的发病率/患病率是多少？英国 PCOS 的经济负担是多少？
PCOS 女性中 2 型糖尿病的发病率和患病率分别为每 1000 人年 3-33 例和 26.5%，英国每年与 PCOS 相关的医疗保健负担至少为 2.37 亿英镑。
尽管已经设计了观察性研究来评估 PCOS 女性的糖尿病发病率，但由于随访时间短、样本量小或 PCOS 的诊断无效，这些研究受到了批评。只有一项研究估计了 PCOS 的与医疗保健相关的经济负担，报告称美国每年的成本为 43.6 亿美元。
研究设计、规模、持续时间：这是一项使用英国初级保健数据库 2004 年至 2014 年期间的个体患者数据和文献中的汇总数据进行建模的研究，以获得 PCOS 疾病进展的转化率。应用模拟方法对 PCOS 的人群动态进行了 25 年的随访。
参与者/材料、设置、方法：从初级保健数据库中选择了 14135 名患有 PCOS 或有 PCOS 症状的女性，以估计确诊 PCOS 和 2 型糖尿病的发病率。模拟了一个包括整个 PCOS 人群的“虚拟”队列（根据英国人口普查数据估计的规模），以模拟 PCOS 的人群动态。进一步从医疗保健的角度进行了经济和效用分析。
可能诊断为 PCOS 的患者的最大转化率为每年每 1000 人 121 例。2 型糖尿病的最大发病率为每 1000 人 33 例。在 25 年的随访中，估计 PCOS 人群中糖尿病的患病率为 26.5%（95%置信区间：25.4-27.8%）。根据我们的保守估计，在考察期间，PCOS 的年度医疗保健负担至少为 2.37 亿英镑。
局限性、谨慎的原因：由于缺乏数据，无法进行包括与 PCOS 相关的所有合并症的医疗保健成本在内的全面经济评估。模型所代表的现实情况的简化可能是一个问题。
这项研究表明，许多有 PCOS 症状的女性从未得到明确诊断，但可能迅速发展为糖尿病。这大大降低了患者的生活质量，并给医疗保健提供者带来了高昂的成本。由于 PCOS 女性的糖尿病风险与糖尿病高风险人群相似，因此将她们纳入国家筛查计划可能具有成本效益。
研究资金/利益冲突：本研究无资金支持。没有利益冲突。
不适用。
