title: Economic analysis of contraceptives for women.
abstract: OBJECTIVE
  To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States.
  
  
  METHODS
  A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables.
  
  
  RESULTS
  Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively.
  
  
  CONCLUSIONS
  From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.
authors.affiliation: Department of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ccchiou@cerner.com
authors.forename: Chiun Fang
authors.initials: CF
authors.lastname: Chiou
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: Eileen
authors.initials: E
authors.lastname: Reyes
authors.forename: Kevin
authors.initials: K
authors.lastname: Knight
authors.forename: Joel
authors.initials: J
authors.lastname: Wallace
authors.forename: Jay
authors.initials: J
authors.lastname: Udani
authors.forename: Karen
authors.initials: K
authors.lastname: Oda
authors.forename: Jeff
authors.initials: J
authors.lastname: Borenstein
mesh_terms: D000328:Adult; D003268:Contraception Behavior; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D018803:Models, Economic; D012102:Reproductive Control Agents / Q000191:economics*; D014481:United States
chemical_list: D012102:Reproductive Control Agents