Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

Ferreira, Jéssica Mayra; Monteiro, Ilza; Fernandes, Arlete; Bahamondes, M. Valeria; Pitoli, Ana C.; Bahamondes, Luís

doi:10.1136/jfprhc-2016-101569

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…An important limitation of all studies was the quality of the effectiveness data used. Many studies relied on the same one or two papers for their methods and inputs, many of which are now out of date . This will affect whether the rates of ‘typical use’ reflect current practice, both in terms of utilisation and resulting failure rates.…”

Section: Discussionmentioning

confidence: 99%

Reviewing the cost‐effectiveness of long‐acting reversible contraceptive methods in an Australian context

Lynch

Lourenço

Flattery

et al. 2018

Aust NZ J Obst Gynaeco

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Background: Relative to the oral contraceptive pill, uptake of long-acting reversible contraceptive methods (LARCs) in Australia continues to be lower than might be suggested by the evidence on their clinical and economic benefits. Aim:To undertake a critical appraisal of published economic evaluations of LARCs to assess the generalisability of their results to the Australian healthcare context. Materials and Methods:A search of the literature was conducted to identify studies of economic evaluations of LARCs using the Medline, Embase and PubMed databases. The quality of the studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: A total of 1009 citations were screened, from which 20 papers, typically reporting the cost per pregnancy avoided, were reviewed. The overall quality of the studies varied but was generally poor (average score of 62/100). To aid comparisons, results have been grouped under the headings IUS (all hormonal intrauterine systems), IUDs (all non-hormonal intrauterine devices), injectables (all contraceptive injections) and implants (all subdermal contraceptive implants).Overall, the results indicated that LARCs were more effective and less costly than oral contraceptives. Conclusions:Despite evidence that LARCs represent value for money, limitations in study quality and approaches must be taken into account when applying these results to Australia. Differences in healthcare settings aside, LARCs may also have benefits beyond their effect on pregnancy that might be captured in broader analyses, such as cost-benefit analyses using willingness to pay methods. These would capture benefits beyond health, which seem to be particularly relevant to contraception. K E Y W O R D Scontraception, cost-effectiveness, costs, literature review, long-acting reversible contraceptive methods

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Section: Discussionmentioning

confidence: 99%

Reviewing the cost‐effectiveness of long‐acting reversible contraceptive methods in an Australian context

Lynch

Lourenço

Flattery

et al. 2018

Aust NZ J Obst Gynaeco

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“…Satisfaction rates for LARC were higher than for the pill (over 80% versus 54%) (Peipert et al , 2011). Another study conducted in Brazil showed that the provision of no-cost LARC decreased not only the rates of UPs but also maternal-infant mortality and morbidity, and induced abortion rates (Bahamondes et al , 2014; Ferreira et al , 2017).…”

Section: Success Of Larc In Reducing Rates Of Unwanted Pregnancy In Omentioning

confidence: 99%

“…Women of lower socioeconomic levels have more difficulty in accessing LARC due to insufficient availability at public services, high cost at private services, or the lack of reimbursement by private insurance. However, one study showed that when LARC were offered at no cost for potential users, they were well accepted and contributed to the reduction of UP rates (Peipert et al , 2012; Bahamondes et al , 2014; Ferreira et al , 2017). While this benefit applies to countries of all socioeconomic levels, it had a greater impact in low- and middle-income countries (Peipert et al , 2012).…”

Section: Barriers To Access To Larc In Lacmentioning

confidence: 99%

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations

Bahamondes

Villarroel

Gúzman³

et al. 2018

Human Reproduction Open

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STUDY QUESTION Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women’s and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN, SIZE, DURATION This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS, SETTING, METHOD We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and wo...

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“…Conversely, the sales of LARC methods, the most effective contraceptive methods, have been very low, [18][19][20] even during the recent Zika virus outbreak. 21 This reflects the fact that most women are using contraceptive methods such as COCs, progestin-only pills, injectable and emergency contraceptives, all of which are much less effective than LARC methods.…”

Section: 18mentioning

confidence: 99%

Untitled

2017

Rev Bras Ginecol Obstet

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Rev Bras Ginecol Obstet 2017;39:373-375.Around 50-55% of all births in Brazil are unplanned, and these figures include both unwanted and mistimed pregnancies. 1,2 The overall rate of induced abortion is estimated at 1.5%, with all induced abortions resulting from unplanned pregnancies culminating in an adjusted abortion rate of 2.7%. In many cases, unplanned pregnancies terminate in induced abortions and, since abortion in Brazil is restricted and only allowed under certain circumstances, many of these procedures are unsafe. Indeed, unsafe abortions are estimated to account for 13% of all maternal deaths. 3,4 The cost of unplanned pregnancies weighs not only on the healthcare system but also on society, and involves the cost of abortion care and of unplanned childbirth. When the pregnancy is unplanned, the likelihood of preterm births and low birthweight infants increases, and this scenario implies high costs associated with neonatal care and longterm disabilities. 5,6 The total fertility rate in Brazil has fallen significantly in recent decades, and today stands at 1.8 births per woman. Over the same period, the use of contraceptives has increased. 7,8 Preventing unplanned pregnancies through publicly funded programs is a strategy that has proven to be effective in significantly cutting costs for health services. 9 In this editorial, we will discuss the current situation in Brazil, providing an insight into the inequalities that exist in the provision of contraceptive methods, particularly long-acting reversible contraceptive (LARC) methods, and highlighting the causes and consequences of unplanned pregnancies in Brazil, where fertility planning services are vastly different to those provided in developed countries, and where abortion legislation is restrictive.The Brazilian National Healthcare Service (SUS, in the Portuguese acronym) covers the cost of around 70-75% of all procedures performed in the country, including those related to reproduction. An estimated 1.79 million unplanned pregnancies and 1.47 million planned pregnancies occur annually, with 351 maternal deaths, of which 49 (14%) are attributed to abortions, and 302 to complications resulting from miscarriages and childbirth. The number of infant deaths in the first year of life is estimated at 32,864. The model estimates the number of preterm deliveries attributed to unplanned pregnancies at 122,523. The estimated number of neonatal admissions associated with unplanned pregnancies was 224,631 for 2010, including all preterm deliveries and 7.6% of all term deliveries. 10 Consequently, the total annual costs attributed to unplanned pregnancies are estimated at R$4.1 billion or more, depending on the exchange rate. Approximately R$4.07 billion (99.2%) of that total amount is attributed to childbirth and its resulting complications. Based on national cost estimates and the number of unplanned pregnancies per year, the cost per unplanned pregnancy is calculated at R $4,439. However, this is based only on cases occurring within the public healthcare sys...

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Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

Cited by 7 publications

References 11 publications

Reviewing the cost‐effectiveness of long‐acting reversible contraceptive methods in an Australian context

Reviewing the cost‐effectiveness of long‐acting reversible contraceptive methods in an Australian context

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations

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