Original research articleEconomic analysis of contraceptives for women
Introduction
Contraceptives help couples to choose the number and timing of their pregnancies [1]. Unintended pregnancy is expensive both to women and to society in terms of medical costs, the costs of caring for more children and attaining personal/professional goals [2]. For example, it was estimated that 3.04 million women in the United States experienced an unintended pregnancy in 1994, resulting in an average $3200 in medical costs per pregnancy [3], [4]. Additional resources are required for welfare programs, such as the Special Supplemental Program for Women, Infants and Children [5].
A wide variety of contraceptive methods has been developed for women, including hormonal contraceptives (oral contraceptives, implants, injectables, the contraceptive patch and vaginal rings), intrauterine devices (IUDs), intrauterine system (IUS), barrier methods (female condoms, diaphragms, cervical caps and spermicides) and surgical methods (tubal ligation). From the user’s perspective, the choice of contraceptive method depends on factors such as effectiveness, whether long- or short-term contraception is desired, history of relevant medical conditions and personal preferences [6]. Choice of method is often based on method costs. Reversible methods such as IUS, IUD and implants, which might be most effective are among the least utilized, possibly due to their high initial costs; yet over time these might be the least costly methods [1].
Contraceptive coverage has been available throughout the Federal Employees Health Benefits Program (FEHBP) since 1999. Twenty states (AZ, CA, CT, DE, GA, HI, IA, ME, MD, MA, MO, NV, NH, NM, NC, NY, RI, TX, VT, WA) have passed Contraceptive Equity Acts, which require insurance plans that provide any prescription drug coverage to cover prescription contraceptives to the same extent (but not necessarily every brand). Many other states, as well as the federal government, are now considering similar legislation [7]. In an era of increasingly constrained resources, health care decision makers are being held accountable for choosing options that optimize value received for resources expended. Thus, there is a need for good evidence on the costs and effectiveness of different contraceptive options. The objective of this study is to examine the economic consequences resulting from use of various female contraceptive alternatives available in the United States.
Section snippets
Decision analytic model
A Markov model was constructed to evaluate nine contraceptive methods for women who do not intend to have children for at least 5 years. This analysis was conducted from the perspective of the health care services payer, typically a third-party such as a health plan or provider organization, including plans where patients bear some costs through deductibles and copayments. For uninsured patients, costs are borne by patients or third parties such as federal, state and local governments. Costs
Effectiveness
The average expected success rate ranged 84.5–99.7%. The five most effective methods were tubal ligation, LNG-20 IUS, copper T 380A IUD, 3-month injectable and oral contraceptives with average annual expected success rates of 99.7%, 98.9%, 98.5%, 98.3% and 96.2%, respectively (Table 3).
Cost
Five-year costs ranged from $1646–$3831. The three least costly methods were LNG-20 IUS, copper T 380A IUD and 3-month injectable, with total 5-year costs per person of $1646, $1678, and $2195, respectively (
Discussion
Although the IUS and IUD methods have high costs for the actual device, they have lower total method costs and better effectiveness when compared to oral and barrier contraceptive methods. Since the costs for pregnancies resulting from contraceptive failure are relatively great, long-term methods with higher effectiveness rates are generally expected to be more cost-effective, especially as the initial costs are amortized over longer time periods. The results of this economic analysis support
Acknowledgements
This study was supported by a research grant from Berlex Laboratories, Incorporated. Montville, NJ, USA.
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2015, ContraceptionCitation Excerpt :Some provider attitudes and lack of awareness of the IUD’s suitability and appropriateness as a first-line method for teens and nulliparous women may limit use [9]. Other proximal determinants that might impair a teen’s contraceptive selection include cost [10]; fear of placement [11]; and lack of knowledge, familiarity or preference for an IUD. [12,13] Relationship dynamics, or the partner’s role in contraceptive decision-making, likely also affect an adolescent’s use of contraception [14–16].