(B-121) Yearly Prevalence of Polycystic Ovary Syndrome (PCOS) Diagnosis in the United States and the Uptake of Management Treatment Following Diagnosis in Commercially Insured Women Aged 18-44

Background: Studying polycystic ovary syndrome (PCOS) is challenging, in part due to differing methods for identifying these patients in large databases.

Objectives: To estimate yearly prevalence of PCOS, co-morbidities, and treatments, comparing across study populations identified using different claims-based algorithms.

Methods: We used data from privately insured women aged 18-44, with ≥1 month of health and pharmacy insurance, in the Merative MarketScan database (2000-2022). ICD codes identified PCOS symptoms (anovulation, hyperandrogenism, and polycystic ovaries). PCOS was classified using 3 diagnostic criteria: Rotterdam (requiring 2 of anovulation, hyperandrogenism, or polycystic ovaries), NIH (requiring anovulation and hyperandrogenism), and Androgen Excess society (AES) (requiring hyperandrogenism plus either anovulation or polycystic ovaries). Patients were classified with PCOS when final diagnostic criterion was met. Due to symptom overlap we excluded individuals with diagnosis codes for hypothyroidism. We identified a fourth cohort using diagnosis codes for polycystic ovaries alone (256.4, 628.0, E28). Prevalence, medication for symptom management (metformin, spironolactone, hormonal contraceptives), comorbidities, and fertility treatment (clomiphene, letrozole) in the year before and after diagnosis, until disenrollment, were compared across cohorts.

Results: During 2002-2022, the number of individuals classified with PCOS was highest using Rotterdam criteria (559,441) followed by AES (N=468,621), NIH (N=444,772) and ICD (N=257,071). The greatest increase in prevalence was seen in the Rotterdam group (e.g., 435 to 1420 per 100,000 vs 195 to 924 per 100,000 in the ICD group). Common comorbidities among the Rotterdam cohort included anxiety/depression (26.2%), obesity (13.1%), migraine (8.2%), and type 2 diabetes (T2D) (3.2%). In the ICD group, depression/anxiety was similar (24.4%), while obesity (23.8%) and T2D (8.2%) were more common. Spironolactone and hormonal contraceptive use were comparable between cohorts. Metformin use among non-T2D patients was higher when comparing ICD (24.8%) to Rotterdam (6.8%). Clomiphene prescription was observed in 2% of the ICD cohort and in 1% of the Rotterdam group, with 81% and 70% initiating post-diagnosis, respectively. Letrozole prescriptions were observed in 2% of the ICD group, with 87% post-diagnosis initiation, but rare ( < 1%) in the Rotterdam group.

Conclusions: PCOS prevalence increased over time and with broader diagnostic criteria. Lack of consistent diagnostic criteria impacts cohort definitions, influencing prevalence estimates and the understanding of comorbidities and treatments in this growing population.