Abstract
Background
The study was conducted to estimate the relative cost effectiveness of contraceptives
in the United States from a payer's perspective.
Methods
A Markov model was constructed to simulate costs for 16 contraceptive methods and
no method over a 5-year period. Failure rates, adverse event rates and resource utilization
were derived from the literature. Sensitivity analyses were performed on costs and
failure rates.
Results
Any contraceptive method is superior to ���no method���. The three least expensive
methods were the copper-T intrauterine device (IUD) (US$647), vasectomy (US$713) and
levonorgestrel (LNG)-20 intrauterine system (IUS) (US$930). Results were sensitive
to the cost of contraceptive methods, the cost of an unintended pregnancy and plan
disenrollment rates.
Conclusion
The copper-T IUD, vasectomy and the LNG-20 IUS are the most cost-effective contraceptive
methods available in the United States. Differences in method costs, the cost of an
unintended pregnancy and time horizon are influential factors that determine the overall
value of a contraceptive method.
Keywords
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References
- Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.Perspect Sex Reprod Health. 2006; 38: 90-96
- The cost of unintended pregnancy in the United States.Contraception. 2007; 75: 168-170
- Use of contraception and use of family planning services in the United States: 1982���2002.Adv Data. 2004; : 1-36
- Economic analysis of contraceptives for women.Contraception. 2003; 68: 3-10
- Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.Am J Public Health. 1997; 87: 932-937
- Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth.Vital Health Stat 2. 2005; 23: 1-160
- Contraceptive technology.19th rev. ed. Ardent Media, New York (NY)2007
- Pregnancy during the use of levonorgestrel intrauterine system.Am J Obstet Gynecol. 2004; 190: 50-54
- Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users.BJOG. 2000; 107: 335-339
- Incidence, trends, and risks of ectopic pregnancy in a population of women.Br Med J (Clin Res Ed). 1981; 282: 15-18
- The pharmacodynamics and efficacy of Implanon. An overview of the data.Contraception. 1998; 58: 91S-97S
- The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group.N Engl J Med. 1997; 336: 762-767
- The levonorgestrel intrauterine system in contraception.Steroids. 2000; 65: 693-697
- The economic value of contraception: a comparison of 15 methods.Am J Public Health. 1995; 85: 494-503
- Comparison of efficacy, cycle control, and tolerability of two low-dose oral contraceptives in a multicenter clinical study.Contraception. 1999; 60: 269-274
- Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol.Contraception. 2006; 73: 223-228
- Association between diaphragm use and urinary tract infection.JAMA. 1985; 254: 240-245
- Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: a randomized controlled trial.JAMA. 2001; 285: 2347-2354
- Bleeding patterns of women using extended regimens of the contraceptive vaginal ring.Contraception. 2007; 75: 204-208
- A prospective study of risk factors for symptomatic urinary tract infection in young women.N Engl J Med. 1996; 335: 468-474
- Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women.Am J Epidemiol. 1996; 144: 512-520
- Drug topics red book. Thomson Healthcare, Montvale (NJ)2007
Cerner Multum��� Lexicon, 2007.
- Price Rx drug price and reference tool (Medi-Span Master Drug Database).(Available at) ([Accessed October 2007])
- Pharmacy directory: drug prices.(Available at) ([Accessed March 2008])
- Current procedural terminology (CPT). American Medical Association, Chicago (IL)2007
- Vasectomy in the United States, 1991.Am J Public Health. 1995; 85: 644-649
- Tubal sterilization in the United States, 1994���1996.Fam Plann Perspect. 2001; 33: 161-165
- Ingenix DRG Expert. Ingenix, Eden Prairie (MN)2007
- Abortion incidence and services in the United States in 2000.Perspect Sex Reprod Health. 2003; 35: 6-15
- The accessibility of abortion services in the United States, 2001.Perspect Sex Reprod Health. 2003; 35: 16-24
- Centers for Disease Control and Prevention. Surveillance summaries. MMWR Morb Mortal Wkly Rep. vol. 55, No. SS-11.(Available at) ([Accessed March 2008])
- The healthcare costs of having a baby.(Available at) ([Accessed June 2008])
- Health care expenses for uncomplicated pregnancies. Research Findings No. 27.(Available at) ([Accessed March 2008])
- Hospitalizations related to childbirth, 2003. HCUP Statistical Brief #11. Agency for Healthcare Research and Quality, Rockville, MD.(Available at) ([Accessed November 2007])
- Healthcare Cost and Utilization Project (HCUP).(Available at) ([Accessed June 2008])
- Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study.Contraception. 2003; 67: 87-91
Trussell J, Koenig J, Stewart F, Darroch JE. Medical care cost savings from adolescent contraceptive use. Fam Plann Perspect 1997;29:248���255, 295.
- Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception.Royal College of Obstetricians and Gynecologists (RCOG), London (UK)2005
- The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline.Hum Reprod. 2008; 23: 1338-1345
- Relative cost effectiveness of Depo-Provera, Implanon, and Mirena in reversible long-term hormonal contraception in the UK.Pharmacoeconomics. 2004; 22: 1141-1151
- Economic analysis of long-term reversible contraceptives. Focus on Implanon.Pharmacoeconomics. 2000; 17: 209-221
Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999;31:64���72, 93.
- Discontinuation and resumption of contraceptive use: results from the 2002 National Survey of Family Growth.Contraception. 2008; 78: 271-283
- Therapeutic effects of the levonorgestrel-releasing intrauterine system in the treatment of idiopathic menorrhagia.Fertil Steril. 2003; 79: 963-969
- Overstating cost savings from contraceptive use.Eur J Contracept Reprod Health Care. 2008; 13: 219-221
Article info
Publication history
Published online: September 26, 2008
Accepted:
August 18,
2008
Received in revised form:
August 16,
2008
Received:
July 29,
2008
Footnotes
���This study was supported by a research grant from Bayer HealthCare Pharmaceuticals, Wayne, NJ, USA.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
