Cost Of Unintended Pregnancy Research Articles

12. The Cost of Unintended Pregnancies (CoUP) in Canadian Adolescents and the Potential Impact of Increased Use of Long Acting Contraceptives

12. The Cost of Unintended Pregnancies (CoUP) in Canadian Adolescents and the Potential Impact of Increased Use of Long Acting Contraceptives

Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis

Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. The purpose of this study was to conduct a cost-savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. The Contraceptive CHOICE Project was a prospective cohort study of 9256 reproductive-age women who were enrolled between 2007 and 2011. Study follow-up was completed October 2013. This analysis includes 5061 Contraceptive CHOICE Project participants who were current Missouri Medicaid beneficiaries or were uninsured and reported household incomes <201% of the federal poverty line. We created a simulated comparison group of women who were receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the Contraceptive CHOICE Project. Data about contraceptive use for the comparison group (N=5061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison that would account for the difference in the 2 populations, we used our simulation model to estimate total Contraceptive CHOICE Project costs and total comparison group costs. We reported all costs in 2013 dollars to account for inflation. Among the Contraceptive CHOICE Project participants who were included, the uptake of intrauterine devices and implants was 76.1% compared with 4.8% among the comparison group. The estimated contraceptive cost for the simulated Contraceptive CHOICE Project group was $4.0 million vs $2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated Contraceptive CHOICE Project group compared with the comparison group were 927 and 483, respectively, which represented a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the Contraceptive CHOICE Project was $5.0 million (40.7%) over the project duration. A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.

Cost of unintended pregnancy in Sweden — a possibility to lower costs by increasing LARC usage

ObjectivesThe objective of this study was to determine the cost of unintended pregnancy (UP) in Sweden and savings generated by a switch of 5% of women from short-acting reversible contraception (SARC) and other methods to long-acting reversible contraceptives (LARCs). Study designWe constructed an economic model to estimate the number and costs of UPs and contraceptive use over a 1-year period. The population consisted of all women aged 15–44years requiring reversible contraception and at risk of UP. UPs could result in birth, spontaneous abortion, induced abortion, and ectopic pregnancy. The model included costs incurred by the healthcare payer or out-of-pocket expenses by women, and indirect costs, i.e., foregone wages from time away from work. ResultsWe estimated 73,989 unintended pregnancies yearly, amounting to costs of almost €158 million. A 5% switch from non-LARCs to LARCs would generate more than 3500 fewer UPs yearly with savings of nearly €7.7 million. The majority of these savings would arise from reduced costs for UPs. ConclusionsUPs are costly for society and women. A small change in the proportion of women using the most effective methods generates substantial cost savings due to fewer UPs and thus fewer abortions. A switch in 5% of women using non-LARCs could prevent more than 3500 UPs yearly, generating savings of more than SEK 70 million (€7.7 million) or of 2.4% of costs for UPs.

The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives.

Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs). A cost model was constructed to estimate the annual number and direct costs of UP in women aged 18 to 44 years. Adherence-associated UP rates were estimated using perfect- and typical-use contraceptive failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC usage. One-way sensitivity analyses were conducted to assess the impact of key variables on scenarios of increased LARC use. There are more than 180 700 UPs annually in Canada. The associated direct cost was over $320 million. Fifty-eight percent (58%) of UPs occurred in women aged 20 to 29 years at an annual cost of $175 million; 82% of this cost ($143 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $34 million in all three switching scenarios; the largest savings ($35 million) occurred when 10% of oral contraceptive users switched to LARCs. The minimum duration of LARC usage required before cost savings was realized was 12 months. The cost of UPs in Canada is significant and much of it can be attributed to imperfect contraceptive adherence. Increased LARC uptake may reduce contraceptive non-adherence, thereby reducing rates of UP and generating significant cost savings, particularly in women aged 20 to 29.

Direct costs of unintended pregnancy in Spain

Objective The aim of the study was to estimate the burden and direct medical costs of unintended pregnancy to the public payer in Spain.Methods An economic model evaluating the costs and outcomes of contraceptive use over a 1-year period was constructed for women in Spain aged 15 to 44 years at risk of pregnancy. Model inputs were derived from published literature and national survey data. Outcomes evaluated included: (i) the annual number of unintended pregnancy events and their cost; (ii) the proportion of unintended pregnancy events and their cost due to non-adherence; and (iii) the use and cost of contraceptive methods in Spain.Results Of the total number of pregnancies, 35% are estimated to be unintended and are associated with a direct cost burden of €292.8 million per year. Most unintended pregnancies (26%) occur in women aged 30 to 34 years, whilst 69% of the total cost burden is estimated to be attributable to poor adherence to contraceptive methods.Conclusions The cost associated with unintended pregnancy is high. The major proportion of the burden is estimated to be attributable to imperfect adherence and is likely avoidable. Shifts in patterns of contraceptive use, combined with measures to improve adherence, could have a substantial and positive impact on this burden.Chinese 摘要：目的 本研究目的是估算在西班牙意外妊娠给公众纳税人带来的负担和直接医疗费用。方法 针对西班牙15至44岁有妊娠风险的女性建立一个经济模型，来评价采用避孕措施超过1年的费用和效果。模型的数据的纳入来自公开发表的文献和国家调查数据。效果评价包括以下内容：（1）一年意外妊娠事件的数目和相关费用；（2）由于未坚持使用避孕措施而意外怀孕事件的比例和相关费用；（3）在西班牙避孕措施的应用及相关费用。结果 在总的怀孕人数中，约35%是意外妊娠，与之相关的直接费用负担是每年2.928亿欧元。意外妊娠发生率最高的是30-34岁妇女，为26%，同时，据估算，总费用负担的69%是由于没有很好的坚持使用避孕方法。结论 意外怀孕相关的费用很高。负担的最主要的部分是由于没有很好地坚持采用避孕措施造成，并且这可能是可以避免的。改变避孕方法应用的模式，同时采取一些提高依从性的措施，能够对降低负担产生重大的积极的影响。

Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception

ObjectivesThe objective of this study was to quantify the cost burden of unintended pregnancies (UPs) in Norway, and to estimate the proportion of costs due to imperfect contraceptive adherence. Potential...

Direct costs of unintended pregnancy in the Russian federation.

In 2010, almost every third pregnancy in Russia was terminated, indicating that unintended pregnancy (UP) is a public health problem. The aim of this study was to estimate the direct cost of UP to the healthcare system in Russia and the proportion attributable to using unreliable contraception. A cost model was built, adopting a generic payer perspective with a 1-year time horizon. The analysis cohort was defined as women of childbearing age between 18 and 44years actively seeking to avoid pregnancy. Model inputs were derived from published sources or government statistics with a 2012 cost base. To estimate the number of UPs attributable to unreliable methods, the model combined annual typical use failure rates and age-adjusted utilization for each contraceptive method. Published survey data was used to adjust the total cost of UP by the number of UPs that were mistimed rather than unwanted. Scenario analysis considered alternate allocation of methods to the reliable and unreliable categories and estimate of the burden of UP in the target sub-group of women aged 18-29years. The model estimated 1,646,799 UPs in the analysis cohort (women aged 18-44years) with an associated annual cost of US$783 million. The model estimated 1,019,371 UPs in the target group of 18-29years, of which 88% were attributable to unreliable contraception. The total cost of UPs in the target group was estimated at approximately US$498million, of which US$441 million could be considered attributable to the use of unreliable methods. The cost of UP attributable to use of unreliable contraception in Russia is substantial. Policies encouraging use of reliable contraceptive methods could reduce the burden of UP.

The burden of unintended pregnancies in Brazil: a social and public health system cost analysis.

BackgroundUnintended pregnancy (UP) is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010.MethodsThe consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$]) within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources.ResultsWe estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3%) attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8%) and R$4.07 billion (99.2%) attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%), with labor and delivery responsible for most costs (R$988 million; 24.3%) for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3%) with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%). Based on the national cost, we estimate the cost per UP to be R$2,293.ConclusionDespite weaknesses in precise estimates in annual pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality.

Systematic Literature Review of the Costs of Pregnancy in the US

The cost of pregnancy is increasing over time despite the decline in pregnancy rates. To fully elucidate and evaluate the cost drivers of pregnancy in the US for payers, a systematic review was conducted to understand the main cost components and primary factors that contribute to the direct costs of pregnancy, pregnancy-related complications and unintended pregnancy among women of childbearing age (15-44 years). We performed electronic searches in the PubMed database from January 2000 to December 2012, and major women's health and pharmacoeconomics conference proceedings from 2011 to 2012. The systematic review is comprised of studies that reported pregnancy, pregnancy-related complications, unplanned pregnancy, and pregnancy-induced monetary costs. The review excluded narrative reports, systematic reviews, model-derived cost of pregnancy papers, non-US-based studies, and reports based solely on expert opinions. Two reviewers independently applied the inclusion criteria and assessed the quality of the data collected. Disagreements between reviewers were resolved by consensus or by arbitration through a third party, with reference to the original sources. We collected information on the study design and outcomes for each included study. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines in designing, performing, and reporting of the systematic review. We identified 40 studies from electronic and handsearching methods. We classified studies based on the primary research topic focusing on the overall cost of pregnancy (N = 10), cost of pregnancy-related complications (N = 26), cost of unintended pregnancy (N = 2), cost of planned pregnancy (N = 1), or cost of pregnancy by facilities (N = 1). In the quality assessment, randomized, non-randomized, and retrospective database studies had low to moderate risk of bias. We determined primary cost drivers based on the highest cost reported in each study. The identified cost drivers were inpatient care, pregnancy delivery, multiple births, complicated cesarean sections, high-risk pregnancy, preterm birth, low birth weight, complications due to conditions such as hypertension, diabetes, anemia, and cancer, and in vitro fertilization. In 2008, the overall mean cost per hospital stay for pregnancy-related incidence ranged from $3,306 to $9,234 in 2012 dollars. The mean cost of pregnancy-related complications that led to preterm birth was as high as $326,953 for an infant born at 25 weeks. It is estimated that over 50 % of live births were unintended in the US. The difference in the cost of unintended pregnancy and intended pregnancy was approximately $536 million. One limitation of the systematic review was the exclusion of model-based cost studies which were excluded because of the high level of variation and heterogeneity across sources of reported cost. Another limitation of the review is that the cost of pregnancy perspective is restricted to the US. Preventing pregnancy-related complications and reducing unintended pregnancies may lower the overall economic burden of pregnancy on the US health care system.

PIH13 The Costs of Unintended Pregnancy in Russia

To estimate the costs of unintended pregnancies (UP) over one year within the Russian health care system. We calculated direct medical costs of a UP for women aged 15-44 per 5-year age groups (average per woman and per age group) as sum of the costs of pregnancy outcomes (live birth, termination, foetal loss, ectopic pregnancy) multiplied by the proportions of each pregnancy outcome that occurred following an UP. The costs of hospital and outpatient services for each outcome were calculated on the basis of information on typical practice provided in expert panel interviews, rates of pregnancy complications from federal statistics and reimbursement rates for medical services in obligatory medical insurance in Moscow region, adjusted for the proportion of medical expenditures covered by public budgets. The costs of live births were adjusted for mistimed pregnancies, based on literature data on their proportion for age groups. The numbers of UP were assessed using data from federal statistics on overall pregnancy outcomes and literature data on the proportion of these outcomes due to unintended pregnancies only. Based on the derived numbers we estimated the distribution of UP outcomes for each age group. The average cost of UP per woman varied from 12 635 RUR (€309,68) for age group 15-19 to 17 630 RUR (€432,12) for age group 30-34. There are estimated to be annually 1 705 591 unintended pregnancies occurring in Russia, with direct medical cost amounting to approximately 26,4 billion RUR (€ 647,0 mln) annually. The highest costs are attributed to age groups 20-24 and 25-29, together accounting for 54% of overall cost burden of UP. The analysis has demonstrated that in Russia UPs elicit substantial health system costs, with the major part attributed to women aged 20-29.

PIH11 Cost of Unintended Pregnancy in the UK: A Role for Increased Use of Long-Acting Reversible Contraceptive Methods

Hassan F1, Henry N1, Wichmann K2, Priaulx J3, Filonenko A2 1IMS Health, London, UK, 2Bayer Pharma AG, Berlin, Germany, 3Bayer HealthCare, New Bury, West Berkshire, UK OBJECTIVES: Incidence of unintended pregnancy (UP) is a prominent public health issue and elicits substantial health system costs. The objective of the current analysis was to estimate the direct cost of UP to the National Health Service (NHS) and the proportion of UP costs attributable to poor adherence in the United Kingdom (UK). The cost implications of increased long acting reversible contraception (LARC) uptake were also explored. METHODS: An economic model evaluating costs and outcomes over an averaged one year period of contraceptive usage was constructed. Model inputs were derived from published literature and national survey data collected by the Office of National Statistics. Exploratory analyses were conducted to investigate the impact of women aged 20-29 years switching to LARC methods from existing contraceptive usage. Cost-neutrality analysis was also performed whereby the minimum duration of LARC usage required to achieve a net cost impact of zero post-switch was assessed. RESULTS: Over 400,000 UPs occur annually in the UK at a rate of 34 per 1,000 women. Direct medical costs were estimated to be £382 million annually. Poor adherence accounted for 67% of all UPs, pertaining to costs of £256 million. In women aged 20-29 years, an estimated 213,794 UPs occurred at a cost of £184 million, 64% of which resulted from imperfect adherence. Switching analyses demonstrated substantial cost savings of £12.5 million in women aged 20-29, when 10% switched from oral contraceptives (OCs) to LARC. The duration of LARC usage required to attain cost neutrality for patients switching from OCs was 1.65 years. CONCLUSIONS: The vast proportion of UPs and associated costs in the UK are attributable to poor contraceptive adherence. Increased uptake of LARC methods in young women may generate significant cost savings to UK health care payers in under 2 years.

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception

BackgroundThis study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure. Study DesignAn economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated. ResultsAnnual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year. ConclusionsImperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence.