title: Economics of reducing menstruation with trimonthly-cycle oral contraceptive therapy: comparison with standard-cycle regimens.
abstract: OBJECTIVE
  To evaluate whether, and under what circumstances, trimonthly-cycle oral contraceptive pill (OCP) therapy is cost saving over standard-cycle OCP therapy for reducing the severity of menstrual-related symptoms.
  
  
  METHODS
  We created three economic models, with each model representing a unique cost perspective (societal, private third party, and patient), to estimate the incremental annual costs associated with women taking trimonthly-cycle rather than standard-cycle OCP. Direct costs considered were costs for OCP prescriptions, female hygiene products, generic over-the-counter pain relievers and iron tablets, home pregnancy tests, and physician visits for menstrual-related concerns. Indirect costs considered were lost wages due to menstruation-related disability and opportunity costs of physician visits. We derived base-case and sensitivity range estimates from prior literature, public use data, expert opinion, and cross-sectional survey data that we collected from 59 adult women taking standard-cycle OCP visiting a large, community-based gynecology office. All costs were adjusted to 2002 US dollars.
  
  
  RESULTS
  Under base-case assumptions that both regimens were equivalently priced (1.16 US dollars/pill) and trimonthly OCP reduces hygiene product use by 50%, annual societal costs per person were 460 US dollars for trimonthly OCP and 501 US dollars for standard OCP (incremental cost savings = 41 US dollars). Assuming no difference in monthly drug copayment costs between the two regimens (5.00 US dollars), annual private third-party costs were nearly identical at 365 US dollars per regimen. Annual patient costs were 95 US dollars for trimonthly OCP and 136 US dollars for standard OCP. Trimonthly OCP remained cost saving to society as long its price remained below a 9% premium to standard OCP prices. The degree to which trimonthly OCP reduces hygiene product use also significantly influenced the cost difference between the two regimens.
  
  
  CONCLUSIONS
  Compared with standard-cycle OCP, trimonthly-cycle OCP appears to be associated with significant societal and patient cost savings. These savings are highly conditional upon trimonthly OCP being priced similarly to standard OCP.
authors.affiliation: School of Professional Studies in Business and Education, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Braunstein
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hausfeld
authors.forename: Joshua
authors.initials: J
authors.lastname: Hausfeld
authors.forename: Andrew
authors.initials: A
authors.lastname: London
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000191:economics*; D017046:Cost Savings; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D017059:Models, Econometric; D011293:Premenstrual Syndrome / Q000188:drug therapy* / Q000191:economics*; D014481:United States
chemical_list: D003277:Contraceptives, Oral, Combined