Abstract
Objectives
Mandatory employer-based insurance coverage of contraception in the US has been a
controversial component of the Affordable Care Act (ACA). Prior research has examined
the cost‐effectiveness of contraception in general; however, no studies have developed
a formal decision model in the context of the new ACA provisions. As such, this study
aims to estimate the relative cost‐effectiveness of insurance coverage of contraception
under employer-sponsored insurance coverage taking into consideration newer regulations
allowing for religious exemptions.
Study design
A decision model was developed from the employer perspective to simulate pregnancy
costs and outcomes associated with insurance coverage. Method-specific estimates of
contraception failure rates, outcomes and costs were derived from the literature.
Uptake by marital status and age was drawn from a nationally representative database.
Results
Providing no contraception coverage resulted in 33 more unintended pregnancies per
1000 women (95% confidence range: 22.4; 44.0). This subsequently significantly increased
the number of unintended births and terminations. Total costs were higher among uninsured
women owing to higher costs of pregnancy outcomes. The effect of no insurance was
greatest on unmarried women 20–29 years old.
Conclusions
Denying female employees' full coverage of contraceptives increases total costs from
the employer perspective, as well as the total number of terminations.
Implications
Insurance coverage was found to be significantly associated with women's choice of
contraceptive method in a large nationally representative sample. Using a decision
model to extrapolate to pregnancy outcomes, we found a large and statistically significant
difference in unintended pregnancy and terminations. Denying women contraception coverage
may have significant consequences for pregnancy outcomes.
Keywords
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Article info
Publication history
Published online: August 16, 2016
Accepted:
August 9,
2016
Received in revised form:
August 8,
2016
Received:
May 4,
2016
Footnotes
☆Funding Source: Support for this research was provided in part by an infrastructure grant for population research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of HealthP2C HD047879 (JT).
☆☆Conflict of Interest Statements:
☆☆W Canestaro has served as a paid consultant for the National Pharmaceutical Council, Genentech and AstraZeneca.
☆☆E Vodicka: none.
☆☆D Downing: none.
☆☆J Trussell serves on advisory boards for Merck and Teva.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
