Estimating the Relative Cost Effectiveness of Four Contraceptive Methods in the Prevention of Unwanted Pregnancies within Department of Defense Active-Duty Women

Abstract

OBJECTIVE: To determine the relative cost effectiveness of depomedroxy progesterone acetate (DMPA), levonorgestrel subdermal implant (LSI), oral tri-phasic tablets (OTPT), and the copper intrauterine device (Cu-IUD) in the prevention of unwanted pregnancies. A further purpose of this research was to estimate the impact each alternative has on the total direct medical costs associated with unwanted pregnancies. DESIGN: Decision analysis, using published clinical outcome probability estimates and actual provider cost data to compare the relative cost effectiveness of the four alternatives. PATIENTS/SETTING: This research was conducted from the perspective of the provider, Department of Defense (DoD) medical treatment facilities. The patients studied were active-duty women in military service receiving contraceptive services. MAIN OUTCOME MEASURES: The average cost per patient for four contraceptive measures. All costs are actual costs to the provider and were provided by 000 Resource Management personnel using standard 000 cost accounting reports. Because the time frame considered was less than 12 months, all costs are depicted in same-year dollars. RESULTS: Costs of providing contraception were much lower for DMPA when compared to OTPT, LSI, and Cu-IUD. Because each alternative is a highly effective therapy, the average cost-effectiveness ratios (cost per successful outcome) were very similar to the average costs. When the prevention of unwanted pregnancies is considered, DMPA is substantially more cost effective than the other alternatives. Further, both OTPT and Cu-IUD are almost equally cost effective, while LSI is the least cost-effective alternative. Additionally, this research demonstrates that the cost effectiveness of DMPA is not sensitive to variations in costs or probability of failure associated with any of the alternatives assessed. Finally, the economic impact to the provider (in terms of direct medical costs) associated with unwanted pregnancies is highlighted by this research.