Cost–benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia

Abstract

Objective Long-acting reversible contraception (LARC) is the most effective form of reversible contraception, but its use in Australia is low compared with other countries. The aim of this study was to evaluate the economic effect of an increase in LARC uptake to international rates. Methods An economic model was designed to assess two scenarios, namely increasing the current rate of LARC uptake of 12.5% to the international benchmark of 14.8% among: (1) women currently using the oral contraceptive pill (OCP); and (2) women at risk of pregnancy and not using contraception. Model inputs included cost of contraceptive methods, discontinuation rates and abortion and miscarriage costs associated with unintended pregnancies. Results Women who switch from an OCP to LARC would save A$114–157 per year. Those not currently using any contraception who adopt LARC would incur costs of A$36–194 per year, but would reap savings from the reduction in unintended pregnancies. Over 5 years there would be a net saving of A$74.4 million for Scenario 1 and A$2.4 million for Scenario 2. Conclusion Greater use of LARC would result in a net gain in economic benefits to Australia. These benefits are largely driven by women switching from an OCP to LARC who have reduced costs, as well as women wishing to avoid pregnancy who choose to use LARC rather than no method. This evidence will support women making an informed contraceptive choice and policy makers in increasing the accessibility of LARC. What is known about the topic? LARC is the most effective form of reversible contraception, but uptake in Australia is relatively low. What does this paper add? There are economic benefits to society for women who switch from an OCP to LARC, as well as for women who switch from no contraception to LARC. What are the implications for practitioners? The findings of this study will support women in making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.

Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia

“…LARC methods have been shown to be a highly cost-effective means of reducing the rate of unplanned pregnancies. 24,25 Our analysis shows that the ACCORd intervention has the potential to be highly cost-effective, assuming an implicit WTP of A$50 000, 22 in terms of both increasing the number of women using LARC and the longer-term quality of life outcomes. Importantly, we show that the cost-effectiveness of the ACCORd intervention is influenced by both the efficacy of outcomes and the ability to defray start-up costs.…”

Development of a pharmacoeconomic registry: an example using hormonal contraceptives

“… 6 Keen, 2017 (Sierra Leone) [ 58 ] Estimate the costs and benefits of scaling up family planning in Sierra Leone. Pill, condom, injectable, IUD, implant, female sterilization, male sterilization, lactational amenorrhea Payer 5, 12 and 22 years Cost-savings per dollar expenditure Every dollar spent on family planning is expected to save US$2.10 in expenditure on selected social sector services 7 Concepcion, 2019 (Australia) [ 59 ] Evaluate economic effect of an increase in LARC uptake to international rates in Australia LARC methods- etonogestrel implant, copper IUD and hormone releasing IUS Government and consumers 5 years Cost savings per woman per year, cost savings over 5 years Greater use of LARC would result in net gains in economic benefits to Australia Cost-minimization analysis 1 Wilkinson, 2019 (USA) [ 60 ] Analyze Indiana Medicaid’s cost-savings associated with providing adolescents with same-day access to LARC Same day access to LARCs, subsequent visit for LARC placement Payers (Medicaid) 1 year Costs, rates of unintended pregnancy and abortion Providing same-day LARC was cost-saving and associated with lower pregnancy and abortion rate Cost-analysis 1 Janowitz, 1994 (Thailand) [ 61 ] Study the impact of providing implants on method use and costs Implant, IUD and injectable Thailand’s National Family Planning Program 1, 2, 3, 3.5 and 5 CYP Cost per CYP Cost per CYP was higher for implant than for IUD or injectables 2 Koenig, 1996 (USA) [ 62 ] Measure the social costs associated with selected contraceptive methods, comparing them with each other and with the use of no method. Copper-T IUD, diaphragm, implant, injectable, male condoms, OC, tubal ligation Social welfare programs and Medicaid 5 years Total social welfare and direct medical savings from contraceptives Copper-T IUD followed by implant and oral contraceptives resulted in the greatest social welfare and direct medical savings 3 Margulies, 2001 (USA) [ 63 ] Measure use rates of DMPA and OC and compare costs between them to see whe...…”

Changes in use of hormonal long‐acting reversible contraceptive methods in Australia between 2006 and 2018: A population‐based study

“…In order to estimate total current (prevalent) users of LARCs, we utilised previously published data on continuation rates up to three years for the implant and five years for the IUS 7 . This acknowledges that use of LARC may be discontinued by some women before the end of the product’s life cycle for various reasons, such as pregnancy intention or adverse events.…”

“…The levonorgestrel IUS (52 mg) and etonogestrel implant were first marketed in Australia in 2000 and 2001 respectively, with both contraceptives subsidised by the Federal Government’s Pharmaceutical Benefits Scheme (PBS). This makes them highly cost‐effective long‐term methods of contraception 7 . Most recently, a lower dose version of the levonorgestrel IUS (19.5 mg) was also added to the PBS.…”