Bayer cost calculator April 2016 UKWHG02180013b Date of recertification : April 2018

Agenda Purpose of the calculator Data sources Stakeholder feedback Assumptions used in the calculator Demonstrating savings with the calculator Agenda UKWHG02180013b Date of recertification : April 2018

Purpose of the calculator Bayer’s budget impact cost calculator has been developed to help local commissioners understand the value of protecting investment in contraception services and Long Acting Reversible Contraception (LARC). The calculator: Estimates the non-health budget impact of unplanned live births nationally, regionally and for local authorities Using data on live births the calculator provides data for single tier, upper tier and lower tier local authorities Provides a conservative estimate on the non-health savings associated with investing in contraceptive services UKWHG02180013b Date of recertification : April 2018

Public spending on unplanned live births in England There is very little evidence of the financial impact for individual local authorities of full term unplanned pregnancies in their area The calculator therefore shows the relationship between unplanned live births and cost to the council and the broader public sector The calculator estimates the cost of unplanned pregnancies to: Education services Housing services Personal social services (e.g. care and support for children who experience abuse, disability or low income) Social welfare (e.g. child benefit and tax credits) There is a financial impact to local authorities even where central government provides funding. For example, the Department for Education funds individual school places but local authorities pay for school maintenance, supplies, SEN support etc UKWHG02180013b Date of recertification : April 2018

How we built the calculator The Family Planning Association (FPA)’s report Unprotected Nation 20151 to provide the economic model for the cost to the public sector of live births National Survey of Sexual Attitude and Lifestyles (Natsal-3)2 on unplanned live births to estimate the number of unplanned live births Office for National Statistics (ONS) data 3 4 to allow data to be localised, using live births by area of usual residence to highlight deprivation, using indices of multiple deprivation to develop per capita costs, using local authority populations UKWHG02180013b Date of recertification : April 2018

The Family Planning Association (FPA)’s report Unprotected Nation 2015 The FPA’s Unprotected Nation 20151 report, calculated national public sector costs resulting from live-birth pregnancies Health economists put forward the minimum national public expenditure (based on 2015 levels of service) across: Social welfare expenditure Personal social services expenditure Housing expenditure Education expenditure The estimates for public expenditure set out in Unprotected Nation 2015 formed the basis for the development of the calculator UKWHG02180013b Date of recertification : April 2018

National Survey of Sexual Attitude and Lifestyles (Natsal-3) on unplanned pregnancy There is no routinely available data on whether a full term pregnancy was planned or unplanned. However, the National Survey of Sexual Attitudes and Lifestyles (NATSAL) provides an estimate of the number of unplanned pregnancies resulting in full term pregnancies Based on the survey results, the NATSAL- 3 study estimates that 5.7% of unplanned pregnancies result in a full term pregnancy5 We used this figure as the basis for our modelling of the number of unplanned pregnancies per local authority. It is a much more conservative estimate than NICE guidelines, which assumes that 46 per cent of unintended pregnancies result in live births6 UKWHG02180013b Date of recertification : April 2018

Office for National Statistics data The calculator adds further granularity by integrating ONS datasets on local authority populations to provide a ‘per-capita’ estimate of spending. Indices of multiple deprivation are also included, in order to provide deprivation scales for each local authority Data estimating local authority populations (Birth Summary Tables 2014) Data on indices of multiple deprivation (Annual Mid-Year Population Estimates 2014) UKWHG02180013b Date of recertification : April 2018

The impact of deprivation More deprived areas usually have a higher percentage of people requiring costly support, including housing, social services and welfare costs The calculator shows indices of multiple deprivation experienced by people living in an area (reflecting for example income, education, employment and health deprivation) as red, amber and green Red and amber areas will see greater spending as a result of unplanned live births due to higher levels of deprivation UKWHG02180013b Date of recertification : April 2018

Stakeholder feedback The developed calculator was shared with the organisations below and the calculator was updated to reflect their feedback: Department of Health Public Health England Faculty of Sexual and Reproductive Health Advisory Group on Contraception Primary Care Women’s Health Forum Family Planning Association Brook UKWHG02180013b Date of recertification : April 2018

Assumptions built into the calculator The calculator uses a robust but very conservative estimate of the likely number of unplanned live births nationally, regionally and for each local authority It is based upon the most conservative estimates of non-health expenditure for England, which does not include assumptions around deprivation or recent budget cuts Even with the most conservative estimates of non-health spending, using NICE’s estimate for the number of live births from unintended pregnancy multiplies projected expenditure by 5.37 When using the calculator it is important to remember: UKWHG02180013b Date of recertification : April 2018

Alternative approaches to estimating budget impact The calculator uses Natsal’s estimate of the prevalence of unplanned full term pregnancies, recognised as the most robust estimate by the sexual health community Natsal states that 5.7 per cent of live births are unplanned However, NICE has also estimated the number of unplanned live births based on abortion statistics But NICE estimates that 46 per cent of live births are the result of unintended pregnancy UKWHG02180013b Date of recertification : April 2018

NICE / Natsal-3 estimates However, using the NICE figure, the approximate cost to the whole of England for unplanned live births is 5.3 times larger than the Natsal estimate This estimate is still based upon the most conservative estimates of non-health expenditure for England, which does not include assumptions around deprivation An exact like for like comparison between NICE’s estimate and Natsal is not possible This is because NICE’s estimate is based on abortion statistics whereas Natsal is based on live birth statistics UKWHG02180013b Date of recertification : April 2018

Demonstrating public sector savings The calculator demonstrates that significant non-health public sector savings can be secured by reducing rates of unplanned pregnancy With public health budgets under significant pressure, the calculator demonstrates that investing in contraception is highly cost-effective even when NHS spending is excluded UKWHG02180013b Date of recertification : April 2018

References 1 Family Planning Association, Unprotected Nation 2015, November 2015, available at www.fpa.org.uk/influencing-sexual- health-policy/unprotected-nation-2015, accessed on 27 April 2016 2 British National Surveys of Sexual Attitudes and Lifestyles (Natsal-3), 2012, available at www.natsal.ac.uk/natsal-3.aspx, accessed on 27 April 2016 3 Office for National Statistics, Birth Summary Tables 2014, published July 2015, available at http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesengl andandwales/2015-07-15, accessed on 27 April 2016 4 Office for National Statistics, Annual Mid-year Population Estimates: 2014, available at http://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearp opulationestimates/latest, accessed on 27 April 2016 5 London School of Hygiene and Tropical Medicine, The prevalence of unplanned pregnancy and associated factors in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), 2013, available at https://researchonline.lshtm.ac.uk/1367704/1/1-s2.0-S0140673613620711-main.pdf, accessed on 27 April 2016 6 NICE, Clinical Guideline CG30, Long-acting reversible contraception (update), September 2014. Available at: https://www.nice.org.uk/guidance/cg30/chapter/1-recommendations 7 Data on file UKWHG02180013b Date of recertification : April 2018