Cost-Benefit Analysis on Health Effects of Contraceptive Methods Elizabeth O’Neill, ECON 539,

Central Questions: What are the net health effects and subsequent costs resulting from using various methods of contraception as compared to not using contraception? What are the policy recommendations based on the results? Reference: Sonnenberg, R., Burkman, R., Hagerty, G., Speroff, L., Speroff, T. (2004) Costs and Net Health Effects of Contraceptive Methods. Contraception. 69:

Methods Data source: 1995 National Survey of Family Growth monitoring a 2 yr. period. Sample: Women y.o. who are not attempting to become pregnant during the duration of the study. Causal statement: Thirteen methods of contraception affect various health factors including cancer, cardiovascular, infections and pregnancy but are more effective and less costly than not using a contraceptive.

Units of Analysis Costs were a total $ amount (not disaggregated by private, public or insured costs). Contraceptive methods were expressed in terms of saved quality-adjusted life-years (QALYs). QALY’s are calculated by multiplying each increment of survival by the utility of the increment. Model assumes women will use same method(s) continuously = benefits & cost savings overestimated in the report.

Cost (US $) Marginal cost (US $) Quality-adjusted life-years Marginal quality-adjusted life-years Cost savings vs. number of methods Pregnancies avoided per woman vs. # of methods QALY gains vs. # methods Cost-Benefit Analysis Factors

Summary of Results

Detailed Cost-Utility Results  Least expensive method varies for different time periods: Within 1 year: DMPA (3-month injectable) is the least costly ($5,103 savings) Within 2+ years: Vasectomy is the least costly ($17,300 saved over a 5-year period)  Any contraceptive method used provided substantial healthcare savings and an increase in QALYs.  Methods that require “user intervention less often than daily are the least costly and most effective” (Sonnenberg et al, 2004).

Policy Implications Managed care organizations/health plans should consider providing some contraceptive services as a cost saving measure. Promote DMPA for short-term pregnancy prevention and vasectomies for longer-term prevention through physician and patient education. Further studies needed to determine public/private payment effects on the findings. Questions?