Table 1 Summary of economic evaluations and quality of life studies retrieved from HC pharmacoeconomic registry
From: Development of a pharmacoeconomic registry: an example using hormonal contraceptives
| Â | Author, year, country and reference | Objective | Interventions considered | Perspective | Time horizon | Cost effectiveness measure | Major finding |
|---|---|---|---|---|---|---|---|
Cost-Effectiveness Analysis | Â | ||||||
1 | Kee, 1972 (Singapore) [22] | Cost-effect analysis of a family planning program | OCs, condoms, IUD | Singapore National Family Planning Program | 3.5 years | Cost per birth prevented | Cost per birth prevented lowest for condom, followed by IUD and oral |
2 | Ashraf, 1994 (USA) [23] | Compare cost effectiveness of 8 methods | LNG implant, MPA injectables, OCs, copper-T IUD, vasectomy, tubal ligation, condom, diaphragm | Institutional | 5,8 and 15 years | Net direct cost per pregnancy-free year | IUD most cost-effective, followed by LNG implants among reversible methods. Sterilization most cost-effective overall |
3 | Trussell, 1995 (USA) [24] | Compare effectiveness and costs of 15 contraceptive methods | Tubal ligation, vasectomy, OCs, implant, injectables, progesterone-T IUD, copper-T IUD, diaphragm, male condom, female condom, sponge, spermicides, cervical cap, withdrawal and periodic abstinence | Private and publicly funded payer | 1 and 5 years | Total costs | Over 5 years, copper-T IUD was most cost-effective followed vasectomy, implant, and injectable |
4 | Hughes, 1996 (UK) [25] | Assess cost effectiveness of family planning services | OCs, injection, implant, IUD, condom, diaphragm, spermicide | National Health Service | 1 year | Cost per pregnancy avoided, cost per CYP | IUD is most cost-effective followed by condom and implant |
5 | Trussell, 1997 (USA) [26] | Examine the cost and savings of contraceptive use in adolescent women compared with no method | Cervical cap, diaphragm, female condom, implant, injectable, male condom, OCs, periodic abstinence, spermicides, sponge, withdrawal, no method | Private and public payer | 1 and 5 years | Total costs | All methods of contraception are cost-saving compared to no method. Extent of savings depend upon method |
6 | Phillips, 2000 (UK) [27] | Compare economic impact of long-acting reversible contraceptives | Implant (Implanon®), implant (Norplant®), LNG-IUS (Mirena®) and injectables (Depo-Provera®) | Payer | 3 years (Implanon), 5 years (Mirena and Norplant) | Cost per pregnancy avoided | Implanon® more cost-effective than Norplant®, Mirena®, Depo Provera® |
7 | French, 2000 (UK) [28] | Estimate cost-effectiveness of implants and IUSs compared to other alternatives | Implant (Norplant®), LNG-IUS (Mirena®), Copper-T IUD, injectable (DMPA) and OC | NHS | 1,2,3 and 5 years | Cost per pregnancy averted | Cost-effectiveness ratios for implants and IUSs quite high versus comparators, explained by low incremental effectiveness |
8 | Nakhaee, 2002 (Iran) [29] | Compare the cost-effectiveness of the seven methods and select the least costly way of providing a given level of contraceptive protection. | OCs, injectables, implants, IUD, tubal ligation, condom, vasectomy | Provider | Couple-year of protection | Cost per adjusted couple year of protection | Vasectomy, IUDs and oral contraceptives most cost-effective |
9 | Chiou, 2003 (USA) [30] | Examine the economic consequences of contraceptives available to women in the United States | LNG-IUS (Mirena®), Copper-T IUD, Injectable, OC, tubal ligation, diaphragm, spermicides, female condom, cervical cap | Third-party payer | 5 years | Cost per average annual successful rate | LNG-IUS and copper-T IUD dominated over all methods except tubal ligation |
10 | Varney, 2004 (UK) [31] | Estimate the relative cost effectiveness of long-term hormonal contraception | LNG-IUS (Mirena®), Implant (Implanon®), MPA injectable (Depo-Provera®) | NHS | 1 year | Annualized expected cost per expected annual number of pregnancies | LNG-IUS or implant are dominant compared to injectable |
11 | Sonnenberg, 2005 (USA) [32] | Quantify impact of increased adherence on the cost-effectiveness of the transdermal contraceptive patch in comparison to combination OCs | Transdermal patch, OC | Payer | 2 years | Cost savings per pregnancies per woman | Patch is cost saving compared with OCs. |
12 | Mavranezouli, 2008 (UK) [33] | Assess cost-effectiveness of LARC methods that are used in the UK when compared to other contraceptive methods | Female sterilization, Implant, LNG-IUS, IUD, injectable (DMPA), OCs | NHS | 1, 2, 3, 5, 10 and 15 years | Cost per average annual number of unintended pregnancies per 1000 women | LARCs dominated OCs. Female sterilization dominated LARC beyond 5 years. DMPA and LNG-IUS least cost-effective LARC |
13 | Trussell, 2009 (USA) [34] | Estimate the relative cost effectiveness of contraceptives in the United States | Copper-T IUD, vasectomy, LNG- IUS, male condom, fertility-awareness based methods, withdrawal, diaphragm, implant, spermicides, female condom, injectable contraceptive, sponge, tubal ligation, vaginal ring, OC, transdermal patch | Payer | 5 years | Five-year cost per average annual rate of not becoming pregnant over 5 years | Copper-T IUD, vasectomy and LNG-IUS are the most cost-effective methods |
14 | Lipetz, 2009 (UK) [35] | Compare the cost-effectiveness of Implanon in comparison to OCs in a community setting | Implant (Implanon®), oral contraceptives | Payer | 1,2 and 3 years | Cost per patient per year of use (outcomes included) | Implanon® is more cost-effective than OCs at all time points |
15 | Ames, 2012 (Canada) [36] | Determine if provision of free IUDs postabortion is associated with a reduction in health-care costs and repeat abortions compared with provision of OCs or DMPA. | Copper-T IUD, OC, injectable, condom | Payer | 5 years | Total cost per woman for contraception and repeat abortions per repeat abortion rates (1 and 5 years) | Immediate insertion of IUDs postabortion associated with lower 5-year rate of repeat abortion and cost reduction versus OCs or DMPA |
16 | Trussell, 2014 (USA) [37] | Evaluate the cost-effectiveness of LNG-IUS 13.5 mg in comparison with SARC methods in a cohort of young women in the US | LNG-IUS 13.5 mg, SARC mixed basket (branded and generic oral contraceptives, ring, patch and injections) | Third-part payer | 3 years | Cost per unintended pregnancies avoided | LNG-IUS 13.5 mg is cost-effective compared to SARC |
17 | Han, 2014 (USA) [38] | Determine the cost-effectiveness of a hypothetical state-funded program offering immediate postpartum implant (IPI) insertion for adolescent mothers. | Immediate postpartum subdermal implant insertion, standard contraceptive initiation | Colorado Medicaid | 6,12,24,36 months | Costs saved per repeat pregnancy rate | At 12, 24 and 36 months, offering IPI is cost-effective |
18 | Heitmann, 2014 (USA) [39] | Estimate the number of unintentional pregnancies in active duty women that could be prevented annually by the use of a LNG-IUS and direct cost savings | LNG-IUS (Mirena®) | US government health care system | 1 year | Cost per number of unintended pregnancy | Use of LNG-IUS could result in significant reductions in unintended pregnancies resulting in cost savings. |
19 | Gariepy, 2015 (USA) [40] | Evaluate the cost-effectiveness of immediate compared with delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy. | Immediate insertion of implant (after delivery but before discharge), Delayed postpartum implant insertion (e.g, at 6 week postpartum visit) | Payer | 1 year | Cost per expected pregnancy rate | Immediate postpartum contraceptive implant is cost-effective in preventing unintended pregnancies |
20 | Trussell, 2015 (USA) [41] | Estimate the average annual cost of available reversible contraceptive methods in the United States and quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation. | Copper IUD, implant, LNG-IUS, generic OC, ring, patch, injection, mixed-SARC, condom | Payer | 1,2,3,4,5 years | Annualized costs by year, per woman (outcome included) | Copper-IUD and LNG-IUS were the least expensive methods. LARC methods become cost-saving relative to SARC methods within 3 years of usage even if they are not used for their full duration of efficacy. |
21 | Canestaro, 2017 (USA) [42] | Estimate the relative cost effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions. | Full contraceptive coverage through an employer-sponsored private health insurance plan (OCs, tubal ligation, IUD, injectable, vaginal ring, transdermal patch, implant) versus no contraceptive coverage | Employer | 1 year | Costs per woman, number of unintended pregnancies | Not providing contraception coverage resulted in greater number of unintended pregnancies resulting in higher total costs among uninsured women. |
22 | Agostini, 2018 (France) [43] | Assess the effectiveness and costs associated with contraceptive methods based on real-world data in France | 1st-2nd generation combined OCs, 3rd generation combined OCs, progestin-only pill, copper-IUD, LNG-IUS, etonogestrel implant | Health system | 2 years | costs including unplanned pregnancies cost | LARCs should be considered for a broader use to prevent unplanned pregnancies. |
Cost-Utility Analysis | Â | ||||||
1 | Sonnenberg, 2004 (USA) [44] | Determine the costs and net health effects of various methods of contraception | Vasectomy, injectable (DMPA), copper-T IUD, LNG-IUD, patch, vaginal ring, OCs, monthly injectable, periodic abstinence, withdrawal, diaphragm, tubal sterilization, no method | Societal | 2 years | Cost per QALY | All contraceptive methods result in substantial cost-saving compared to no use of contraception. Vasectomy resulted in highest cost-savings followed by DMPA, copper-IUD and LNG-IUD |
2 | Babigumira, 2012 (Uganda) [45] | Compare the incremental cost-effectiveness of a hypothetical new contraceptive program that would achieve universal access to modern contraceptives in Uganda, to the current contraceptive program | New contraceptive program (universal access to modern contraceptives in Uganda), current contraceptive program (status quo in which access to modern contraception is limited) | Societal and governmental | Lifetime | Cost per DALY averted, cost per life-year gained, cost per pregnancy averted, cost per unit of fertility reduction | Universal access to modern contraceptives dominated the current contraceptive program and is highly cost-effective. |
3 | Burlone, 2013 (USA) [46] | Model the cost-effectiveness of expanding contraceptive coverage from 185 to 399% FPL for insurance exchange plan providers in Oregon, as it examines the impact of expanded coverage of currently uninsured women in Oregon. | Increase contraceptive coverage to < 399% FPL versus Maintaining contraceptive coverage at < 185% FPL | Oregon state insurance plan providers | 5 years | Cost per number of pregnancies and QALY | Extending contraceptive coverage under the Affordable Care Act is cost-saving and cost-effective |
4 | Henry, 2015 (Sweden) [47] | Evaluate the cost-effectiveness LNG-IUS 13.5 mg (Jaydess®) vs. OC, in women at risk of unintended pregnancy. | LNG-IUS 13.5 mg, oral contraceptive, LNG-IUS (Mirena®), Hormonal market mix of methods | Societal | 3 years | Cost per unintended pregnancy avoided and cost per QALY | LNG-IUS 13.5 mg is generated cost-savings and resulted in fewer unintended pregnancies compared with OCs |
5 | Washington, 2015 (USA) [48] | Determine if immediate postpartum IUD placement prevents pregnancy and is cost-effective compared with routine placement. | Immediate postpartum IUD placement (within 10 min of placental expulsion), routine IUD placement (6–8 weeks postpartum) | Health care | 2 years | Cost per total number of unintended pregnancies and cost per QALY | Immediate postpartum IUD is a dominant strategy over routine IUD placement |
6 | Di Giorgio, 2018 (Uganda) [49] | Assess the cost-effectiveness of self-injected subcutaneous DMPA-SC compared to health-worker-administered intramuscular DMPA (DMPA-IM) | Self-injected subcutaneous DMPA-SC, Health-worker-administered intramuscular DMPA (DMPA-IM) | Societal and health system | 1 year | Costs per pregnancies averted, Costs per DALY averted | Under a societal perspective, self-injected DMPA-SC averted more pregnancies and was cost-saving compared to health worker administered DMPA-IM |
7 | Gumbie 2019 (Australia) [50] | Estimate cost-effectiveness of reclassifying OCs from prescription to pharmacist-only | Prescription-only OCs, pharmacist-only OCs | Healthcare system | 35 years | Cost per QALY | Reclassifying OCs from prescription only to pharmacist-only was more effective and cost saving |
8 | Rodriguez 2019 (USA) [51] | Estimate unintended pregnancies averted and cost-effectiveness of pharmacist prescription of hormonal contraception | With and without pharmacist prescription of hormonal contraception | Payer (Oregon Medicaid) | 1 year | Unintended pregnancies averted, costs and QALYs | Policy expanding scope of pharmacist to prescribe hormonal contraception averts unintended pregnancies and is cost effective |
9 | Mvundura 2019 (Senegal) [52] | Evaluate the cost-effectiveness of self-injected subcutaneous DMPA-SC compared to health-worker-administered intramuscular DMPA (DMPA-IM) | Self-injected subcutaneous DMPA-SC, Health-worker-administered intramuscular DMPA (DMPA-IM) | Societal and health system | 1 year | Costs per DALY averted | Under a societal perspective, self-injected DMPA-SC averted more pregnancies and cost less compared to health-worker administered DMPA-IM |
Cost-benefit analysis | Â | ||||||
1 | Ortmeier,1994 (USA) [53] | Examine the net benefit of four hormonal methods of contraception based on the costs and benefits per patient per day of effective pregnancy prevention | Injectable (DMPA), implant (Norplant®), progestogen only pill (Nor-QD®), combined pill (Ortho-Novum 7/7/7®) | Payer (Managed care) | 1 patient-day | Net benefit per patient per day | All methods have a positive net benefit. DMPA shows highest net benefit, followed by Nor-QD® and Ortho-Novum 7/7/7®). |
2 | Foster, 2009 (USA) [54] | Assess the cost-effectiveness of contraceptive methods dispensed in 2003 for 955,000 women in Family PACT Program- California’s publicly funded family planning program. | Interval tubal ligation, implant, IUD, injectable, ring, patch, OCs, barrier methods, emergency contraceptives | Payer (Family PACT California’s publicly funded family planning program) | Varies depending upon contraceptive method | Cost-savings per dollar expenditure | Implant was most cost-effective followed by IUD, injectables, OCs and patch |
3 | Rodriguez, 2010 (USA) [55] | Examine the hospital and state costs of offering the option of a postpartum IUD to an underinsured population of recent immigrants to the United States with Emergency Medicaid (EM) insurance coverage only | Postpartum intrauterine device (IUD) versus absence of program | Hospital and state | 1,2,3,4 years | Cost-savings per dollar expenditure | Postpartum IUD is cost beneficial from state government perspective but not from hospital perspective |
4 | Onwujekwe, 2013 (Nigeria) [56] | Determine the willingness to pay (WTP) and the benefit-cost of modern contraceptives delivered through the public sector in Nigeria. | Male condom, female condom, OC, injectable, implant, IUD | Public-sector payer | 1 year | Unit price (cost) per mean WTP amount (benefit) | The benefits of providing contraceptives through public sector far outweighed the costs, except for female condoms |
5 | Foster, 2013 (USA) [57] | Examine relative cost-benefit of specific methods and evaluate the relative contribution of each method to the number of unintended pregnancies averted within the Family PACT population. | Tubal ligation, tubal occlusion, copper-IUC, hormonal IUC, implant, injectable, ring, patch, OC, barrier methods, emergency contraceptives | Payer (Family PACT California’s publicly funded family planning program) | Varies depending upon contraceptive method | Cost savings per dollar expenditure | Copper-IUC was most cost-saving followed by implant and hormonal IUC. |
6 | Keen, 2017 (Sierra Leone) [58] | Estimate the costs and benefits of scaling up family planning in Sierra Leone. | Pill, condom, injectable, IUD, implant, female sterilization, male sterilization, lactational amenorrhea | Payer | 5, 12 and 22 years | Cost-savings per dollar expenditure | Every dollar spent on family planning is expected to save US$2.10 in expenditure on selected social sector services |
7 | Concepcion, 2019 (Australia) [59] | Evaluate economic effect of an increase in LARC uptake to international rates in Australia | LARC methods- etonogestrel implant, copper IUD and hormone releasing IUS | Government and consumers | 5 years | Cost savings per woman per year, cost savings over 5 years | Greater use of LARC would result in net gains in economic benefits to Australia |
Cost-minimization analysis | |||||||
1 | Wilkinson, 2019 (USA) [60] | Analyze Indiana Medicaid’s cost-savings associated with providing adolescents with same-day access to LARC | Same day access to LARCs, subsequent visit for LARC placement | Payers (Medicaid) | 1 year | Costs, rates of unintended pregnancy and abortion | Providing same-day LARC was cost-saving and associated with lower pregnancy and abortion rate |
Cost-analysis | |||||||
1 | Janowitz, 1994 (Thailand) [61] | Study the impact of providing implants on method use and costs | Implant, IUD and injectable | Thailand’s National Family Planning Program | 1, 2, 3, 3.5 and 5 CYP | Cost per CYP | Cost per CYP was higher for implant than for IUD or injectables |
2 | Koenig, 1996 (USA) [62] | Measure the social costs associated with selected contraceptive methods, comparing them with each other and with the use of no method. | Copper-T IUD, diaphragm, implant, injectable, male condoms, OC, tubal ligation | Social welfare programs and Medicaid | 5 years | Total social welfare and direct medical savings from contraceptives | Copper-T IUD followed by implant and oral contraceptives resulted in the greatest social welfare and direct medical savings |
3 | Margulies, 2001 (USA) [63] | Measure use rates of DMPA and OC and compare costs between them to see whether these trends impacted pharmaceutical acquisition costs for a family planning program over three time periods (1992, 1994 and 1999) | DMPA, OC | Pharmacy family planning budget | 3 years (1992, 1994 and 1999) | Costs | High cost of DMPA (due to non-availability of generic or competing product) could jeopardize pharmacy to offer this method to women |
4 | Lipetz, 2009 (UK) [64] | Determine how long clients were keeping their contraceptive implants in and cost of implant provision | Implant (Implanon®) | Community based sexual and reproductive health service | 1 year | Costs | The annual cost for using Implanon® was 25% lower than the estimate made by NICE despite a shorter duration of use |
5 | Tumlinson, 2011 (Kenya) [65] | Assess whether implant clients in Kenya are paying as much or more than the direct service delivery cost of Sino-implant (II) | Sino-implant (II) | Patient | 1 year | Costs | Patient fees in private sectors allow for 100% recovery of direct cost of providing Sino-implant (II), therefore potential to reduce reliance on donor-supplied implants thereby improving contraceptive security |
6 | Chin-Quee, 2013 (Zambia) [66] | To determine the incremental cost per CYP of adding injectable contraceptives to the existing community health worker (CHW) family planning program | Adding injectable contraception (DMPA) into existing community health worker’s family planning program | NA | 1 year | Cost per CYP | Provision of injectable contraceptives by CHW is safe, acceptable and feasible in Zambia with high rates of uptake in hard-to-reach areas. |
7 | Salcedo, 2013 (USA) [67] | Evaluate potential cost savings associated with immediate postabortal IUD insertion compared with planned IUD insertion at time of abortion follow up | Immediate postabortal IUD insertion, planned IUD insertion at time of abortion follow up | Public payer | 1, 5 year | Cost savings per woman | Immediate postabortal IUD insertion is cost saving compared to planned IUD insertion at time of abortion follow up |
8 | Cook, 2014 (UK) [68] | Establish the actual costs of providing the IUS in a community sexual and reproductive health setting and compare it to the cost predicted by NICE | Intrauterine system | Community based sexual and reproductive health service | 1 year | Cost per patient per year | Providing IUS in community clinics was 23% cheaper than that predicted by NICE and cheaper than providing combined OCs |
9 | Schnippel, 2015 (South Africa) [69] | Conduct a cost evaluation of establishing a van-based mobile clinic in two rural districts in South Africa that provider cervical cancer screening and other reproductive and primary health services | OC, norethisterone enanthate (injectable), MPA (Injectable), male condoms, female condom | Health service provider | 1 year | Unit cost per patient | Staffing costs are the largest component of providing mobile health services to rural communities. |
10 | Chola, 2015 (South Africa) [70] | Estimate the service delivery cost of scaling up modern contraception, and potential impact on maternal, newborn and child survival | Male condom, female sterilization, male sterilization, injectable contraceptive, Implanon®, OC, IUD | Health service provider | 16 years | Unit costs of contraceptive methods per year, total annual cost of family planning for South Africa | Scaling up family planning can have huge impacts on maternal and child mortality |
11 | Foster, 2015 (USA) [71] | Estimation of how making OCs available without a prescription may affect contraceptive use, unintended pregnancies and contraceptive and pregnancy costs among low-income women | OTC OC access, no OTC access to OCPs | Public sector costs | 1 year | Costs per woman | If out-of-pocket costs for OCs are low, OTC access could increase use of effective contraceptives and reduce unintended pregnancies |
12 | Rademacher, 2016 (Kenya) [72] | Calculate direct service delivery cost per CYP of various family planning methods | Copper-IUD, male sterilization, female sterilization, male condom, Jadelle® implant, Sino-implant (II), Implanon® implant, LNG-IUS, OCs, DMPA injectable, Sayana Press® injectable, NET-EN injectable, female condom | NA | CYP | Costs per CYP | Introduction of LNG-IUS has the potential to increase access and choice for women in Kenya. |
13 | Law, 2017 (USA) [73] | Evaluate differences in mean costs per woman of the use of two IUDS | Mirena® and Liletta® | Payer | 3, 5 and 10 years | Costs per woman | Mirena® was associated with slightly higher cost than Liletta® at 3 years, but was more cost-saving at 5 and 10 years |
14 | Madden, 2018 (USA) [74] | Conduct a cost-savings analysis of Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate value of investment in enhanced contraceptive care | IUD, implant, injectable, OCs, patch, ring, natural family planning, male condom, no method | Missouri Medicaid | 45 months | Total costs for contraceptive CHOICE project and simulated comparison group | Providing no-cost contraception results in substantial cost-savings because of increased uptake of highly effective contraception and averted unintended pregnancy and birth |
Quality of life studies | |||||||
1 | Schwarz, 2008 (USA) [75] | Assess the potential impact of unintended pregnancy on women’s quality of life | NA | Non-pregnant women | NA | VAS, TTO, SG metrics of health state utility values for unintended pregnancy | Provided estimates on the anticipated effects of pregnancy on women’s quality of life to be integrated into CEAs |
2 | Lundsberg, 2017 (USA) [76] | Contribute to decision analysis by estimating utility for different pregnancy contexts | NA | Pregnant women | NA | VAS, TTO, SG, PROMIS GSF-derived utility | Unintended pregnancy is associated with significant disutility. |