Objectives: To calculate the cost of an unintended pregnancy in 2011 and use this cost in a cost-effectiveness model comparing ulipristal acetate (UPA) with levonorgestrel (LNG) for emergency hormonal contraception (EHC).
Design: Retrospective analysis of published data sources and published cost-effectiveness model.
Setting: Women presenting in primary care in England for EHC within 24 or 72 h of unprotected sexual intercourse (UPSI).
Interventions: EHC of either LNG (1.5 mg) or UPA (30 mg).
Primary And Secondary Outcome Measures: The primary outcome measure is the number and direct and indirect costs of an unintended pregnancy. The secondary outcome measure is the consequence of unintended pregnancy: miscarriage, abortion, ectopic pregnancy, stillbirth or live birth.
Results: From the comparative clinical studies of EHC we observe that if 125 women receive either LNG or UPA within 72 h of UPSI, there will be one less pregnancy due to method failure in the UPA group than in the LNG group. We calculate the cost of an unintended pregnancy to be £1663 in direct healthcare costs rising to £2922 with the inclusion of social costs. Using these costs in the comparative cost-effectiveness model shows that it costs £194 less in direct health costs alone to prevent one more pregnancy with UPA than with LNG. The inclusion of social costs of pregnancy increases this cost-saving potential to £1453 for each extra pregnancy avoided with UPA compared with LNG.
Conclusions: Clinical trials have demonstrated the superior efficacy of UPA compared with LNG as a method of EHC. Given that it costs less overall in health and social costs of pregnancy while preventing more pregnancies, UPA is said to be the dominant treatment, and primary care services should shift to offering UPA as the preferred oral option to women presenting within 24 and 72 h of UPSI.
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http://dx.doi.org/10.1136/bmjopen-2013-003815 | DOI Listing |
Contracept Reprod Med
January 2025
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Background: Female Condoms are 90-95% effective against HIV transmission when correctly and consistently used and are also cost-effective. In general, condoms prevent sexually transmitted infections (STIs) and unwanted pregnancies. Although the COVID-19 pandemic had the potential to undermine routine healthcare services delivery and utilisation, there is limited evidence about the pandemic's effect on Female Condom uptake in Gauteng, one of the hardest-hit provinces in South Africa.
View Article and Find Full Text PDFBMJ Sex Reprod Health
January 2025
Chalmers Sexual and Reproductive Health Service, NHS Lothian, Edinburgh, UK.
Background: Pregnancy within a year of childbirth has negative impacts on women and their children's health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our pilot randomised controlled trial (RCT) aimed to establish the feasibility of a main RCT of the effects of the DHI compared with standard care on long-acting contraception use.
View Article and Find Full Text PDFObstet Gynecol
February 2025
Department of Cardiology, the Department of Obstetrics and Gynecology, and the Division of Research, Kaiser Permanente Northern California, and Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, and the Division of Research, Kaiser Permanente, Pleasanton, California.
Objective: To investigate the effects of the Affordable Care Act (ACA) and its elimination of cost sharing on contraception utilization, pregnancy rates, and abortion rates.
Methods: We conducted a retrospective cohort study within a health care system serving more than 4.5 million insured members across 21 medical centers and 250 clinics.
This study examines an inconsistency between an attitude and a behaviour: non-use of contraception among people who are trying to get pregnant. More than one in four people in that situation report using contraception 'sometimes' or 'always' and consequently face the risk of pregnancy. We test three potential explanations: acceptability of having (further) children; perceived low pregnancy risk; and perceived social pressure.
View Article and Find Full Text PDFSubst Use Addctn J
January 2025
Departments of Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Introduction: Young childbearing sexual minority (SM) people are more likely to use cannabis and to have an unintended pregnancy than their heterosexual peers; however, little is known about their perceptions and experiences of peripartum cannabis use. This qualitative study explores the relationships young pregnant and parenting SM people have with cannabis, as well as their feelings and opinions about prenatal cannabis use.
Method: Participants who identified as SM from baseline surveys of the YoungMoms study were recruited for semi-structured qualitative interviews (n = 13).
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