Elsevier

Contraception

Volume 68, Issue 1, July 2003, Pages 3-10
Contraception

Original research article
Economic analysis of contraceptives for women

https://doi.org/10.1016/S0010-7824(03)00078-7Get rights and content

Abstract

Objective

To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States.

Methods

A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT’s 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables.

Results

Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively.

Conclusion

From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.

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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