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The Economic Value of Contraception: A Comparison of 15 Methods

Trussell, James; Leveque, Joseph A.; Koenig, Jacqueline D.; London, Robert; Borden, Spencer; Henneberry, Joan; LaGuardia, Katherine D.; Stewart, Felicia; Wilson, T. George; Wysocki, Susan; Strauss, Michael

Obstetrical & Gynecological Survey: December 1996 - Volume 51 - Issue 12 - p 61S-72S
IUDs: A State-of-the-Art Conference

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 Medi-Cal. 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 $14 122, $13 899, $13 813, and $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 $8933 to $12 239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $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. (Am J Public Health 1995;85:494-503)

Office of Population Research, (J.T.), the Woodrow Wilson School of Public and International Affairs, and the Department of Economics, Princeton University, Princeton, New Jersey; Health Technology Associates, (J.A.L., J.D.K., M.J.S.), Washington, DC; Department of Obstetrics and Gynecology, (R.L.), Kaiser Permanente Medical Group, Mid-Atlantic Region, Baltimore, MD; Wyatt Company, (S.B.), Wellesley, MA; Colorado Department of Health, (J.H.), Denver, CO; Department of Obstetrics and Gynecology, (K.D.L-G.), Cornell University Medical College, New York, NY; Office of Population Affairs, (F.S.), U.S. Department of Health and Human Services, Bethesda, MD; California Department of Health Services, (T.G.W.), Sacramento, CA; National Association of Nurse Practitioners in Reproductive Health, (S.W.) Washington, DC.

Correspondence to: James Trussell, PhD, Office of Population Research, Princeton University, 21 Prospect Ave., Princeton, NJ 08544; fax (609) 258-1418; E:mail trussell@princeton.edu.

This article is being reprinted with permission in its entirety from American Journal of Public Health 1995;85:494-503.

© Williams & Wilkins 1996. All Rights Reserved.