153894 Cost effectiveness of advance provision of emergency contraception

Monday, November 5, 2007

Diana Greene Foster, PhD , Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, San Francisco, CA
Tina Raine, MD, MPH , Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Claire Brindis, DrPH , Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Lynne Cao , University of California, Berkeley, Berkeley, CA
Daria P. Rostovtseva, MS , Bixby Center for Reproductive Health Research & Policy, University of California, San Francisco, Sacramento, CA
Phillip Darney, MD, MSc , Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Introduction: Advance provision, providing women with a supply of emergency contraceptive pills (ECP) prior to an episode of unprotected intercourse, has been shown to increase probability of taking ECP and decrease the time to taking ECP.

Methods: We use cost effectiveness analysis based on a microsimulation of use of ECP and pregnancies of a hypothetical cohort of 500,000 sexually active women with rates of unprotected intercourse ranging from once every four years to twice a month who take EC after 1/3, 2/3 and all episodes of unprotected sex. Cost data are from California's Medicaid program and ECP effectiveness data are from WHO. We compare three regimens – no use of emergency contraception, provision of ECP in advance, on-demand ECP where women seek out ECP from a clinic or pharmacy after unprotected intercourse.

Results: There is a positive return within one year to advance provision of ECP for nearly all sexually active women – from those who experience unprotected intercourse once every four years to those who have unprotected intercourse twice a month. Advance provision has the potential to avert more unintended pregnancies at a lower cost than on demand ECP. Health insurance plans' continued coverage of ECP is projected to be cost effective with returns per dollar spent of $2 to $8 if women take ECPs after every episode of unprotected intercourse.

Discussion: Advance supply of emergency contraception should be provided to all sexually active women, particularly women who are unable to get ECP over the counter at pharmacies including minors.

Learning Objectives:
1. Understand the mechanism of action and effectiveness of emergency contraception 2. Describe the use of microsimulation to model sexual and reproductive behavior. 3. Identify the relationship between frequency of unprotected sexual intercourse and cost effectiveness of advance and on demand provision of emergency contraception. 4. Discuss the benefits of advance provision of emergency contraception and identify the population with the greatest potential gains to advance provision.

Keywords: Economic Analysis, Contraceptives

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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