Economic Burden of Contraception Management in Spain.

Inmaculada Parra Ribes,Ezequiel Pérez Campos,Ignacio Bugella Yudice,Maria Jesús Rodríguez Domingo,Juan José Rascón Poza

doi:10.36469/9785

Abstract

BackgroundA wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods.ObjectivesThis study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period.MethodsA survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure.ResultsReversible contraception costs in Spain amount to €12.5 billion over a 5–year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women’s age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5.ConclusionsLARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.

Highlights

A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS)
The usage of LNG-IUS12 was estimated based on the opinions of experts, who considered that 5% of LNG-IUS20 users and 2.5% of copper intrauterine devices (IUD) users switched to LNGIUS12
In women between 30 and years of age, preferences are for COC, male condom and LNG-IUS20, while from to 49 years, LNG-IUS20 is the preferred contraceptive method, followed by male condom and copper IUD

Summary

Introduction

A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). From 1997 to 2007, Spain experienced a 30.0% increase in the use of contraception.[2] In the Spanish contraception survey of 2016, 71.1% of women of childbearing age, between 14 and 49 years, responded that they used contraceptive methods, while 4.1% did not know/did not answer, and 24.7% of women did not use any contraception.[3] Among the latter, 8.3% did not have sexual intercourse, but the remaining 16.4% of women may be at risk of UP due to the lack of contraception use, or even the use of ineffective methods (1.0%), such as coitus interruptus or natural methods.[3] Among all contraceptive methods used in Spain, reversible methods are employed by 87.3% of women, that is to say, by up to 6.8 million women.[4] Reversible methods include short-acting reversible contraceptives (SARC) (combined oral contraceptives [COC], gestagen-only oral contraceptives [OCs], transdermal patch, vaginal ring, male condom) and LARC (subdermal implant [Implanon NXT®, progestagen-only implant], intramuscular injectable [Depo-Provera®, Medroxyprogesterone Acetate Injectable Suspension)], LNG-IUS and copper intrauterine device [IUD]. The most common methods are male condom and COC, used by 45.7% and 34.9% of women, respectively.[3]

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