Felicia H. Stewart

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving

The effectiveness of the Yuzpe regimen of emergency contraception.

14,122,

Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.

13,899,

Impact of increased access to emergency contraceptive pills: A randomized controlled trial

13,813, and

Extended use of transdermal norelgestromin/ethinyl estradiol: a randomized trial.

13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from

Medical care cost savings from adolescent contraceptive use.

8933 to

Should oral contraceptives be available without prescription

12,239 over 5 years. Oral contraceptives fell between these groups, costing

Evaluation of a media campaign to increase knowledge about emergency contraception.

1784 over 5 years, saving

Commentary: the quest for women's prophylactic methods--hopes vs science.

12,879, and preventing 4.1 pregnancies. CONCLUSIONS Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT Program in California, 1997-1998.

A review of the 10 clinical trials of the Yuzpe method of emergency contraception that reported the data required to calculate effectiveness rates suggests that this may be a more accurate measure of efficacy than the failure rate. The Yuzpe regimen, which involves the administration of 200 mcg of ethinyl estradiol and 2.0 mg of norgestrel, was associated with failure rates ranging from 0.2% to 2.8%; the pooled rate was 1.5% (95% exact confidence interval, 1.2-1.9%). The equality of failure rates across studies was compromised by two assumptions: women lost to follow-up (as high as 22%) became pregnant at the same rate as women observed, and all women in the trials had an equal probability of failure. The effectiveness rate--the proportionate reduction in the probability of conception caused by emergency contraception use--avoids these sources of error by including data on both the observed and expected number of pregnancies and computing the risk of conception for each day of the menstrual cycle. These estimates range from 55.3% to 94.2%, with a pooled effectiveness rate of 74.0% (95% exact confidence interval, 68.2-79.3%). On the other hand, four methodological issues are inherent in use of the effectiveness rate: the assumption of homogeneity implicit in pooling observations, bias introduced by the unknown pregnancy rate among women lost to follow-up, the probability some women violated study protocol and had more than one unprotected act of intercourse during their cycle, and possible underestimation of the expected number of pregnancies.