1. Bayer cost calculator April 2016
UKWHG b Date of recertification : April 2018

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

3. 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
UKWHG b Date of recertification : April 2018

4. 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
UKWHG b Date of recertification : April 2018

5. 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
UKWHG b Date of recertification : April 2018

6. The Family Planning Association (FPA)’s report Unprotected Nation 2015
The FPA’s Unprotected Nation 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
UKWHG b Date of recertification : April 2018

7. 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
UKWHG b Date of recertification : April 2018

8. 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)
UKWHG b Date of recertification : April 2018

9. 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
UKWHG b Date of recertification : April 2018

10. 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
UKWHG b Date of recertification : April 2018

11. 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:
UKWHG b Date of recertification : April 2018

12. 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
UKWHG b Date of recertification : April 2018

13. 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
UKWHG b Date of recertification : April 2018

14. 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
UKWHG b Date of recertification : April 2018

15. References
1 Family Planning Association, Unprotected Nation 2015, November 2015, available at health-policy/unprotected-nation-2015, accessed on 27 April British National Surveys of Sexual Attitudes and Lifestyles (Natsal-3), 2012, available at accessed on 27 April Office for National Statistics, Birth Summary Tables 2014, published July 2015, available at andandwales/ , accessed on 27 April Office for National Statistics, Annual Mid-year Population Estimates: 2014, available at opulationestimates/latest, accessed on 27 April 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 accessed on 27 April NICE, Clinical Guideline CG30, Long-acting reversible contraception (update), September Available at: 7 Data on file
UKWHG b Date of recertification : April 2018