Modelling costs and outcomes of expanded availability of emergency contraceptive use in British Columbia.
BACKGROUND
Emergency contraception (EC) can potentially reduce unwanted pregnancies and abortions. However, these agents are underused due to lack of awareness and barriers to utilization. While earlier economic evaluations have indicated that use of EC is potentially cost-effective, recent evidence of a lower risk of pregnancy following unprotected intercourse than previously reported suggest prior studies may have over-estimated cost savings.


OBJECTIVE
To model cost savings and pregnancy-related outcomes associated with the policy change authorizing pharmacist provision of EC in British Columbia, and to estimate the costs of initiatives to further women's awareness and utilization of EC that would result.


METHODS
Three decision analytic models were developed evaluating current EC utilization (physician-only), EC utilization following pharmacist provision and potential expanded EC awareness and utilization following a public awareness initiative. Models were developed from the Ministry of Health perspective for 2001 using cost and event data from the Ministry supplemented by data from the literature.


RESULTS
Current EC utilization saved the Ministry $2.20 million (95% CR: $0.15 million, $4.90 million) in medical costs the first year, and incremental savings from pharmacist provision was $0.64 million (95% CR: $0.24 million, $1.28 million). A public awareness initiative costing less than $2.57 million (95% CR: $0.22 million, $5.75 million) annually is potentially cost saving.


CONCLUSIONS
Pharmacist provision of EC was cost saving to the Ministry, even when the estimated risk of pregnancy in the population is less than assumed in previous studies. Increasing EC availability directly from pharmacists and increasing EC awareness have the potential to reduce health care costs.
Soon
Judith A
JA
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. jasoon@interchange.ubc.ca
Meckley
Lisa M
LM
Levine
Marc
M
Marciante
Kristin D
KD
Fielding
David W
DW
Ensom
Mary H H
MH
D001955:British Columbia; D003281:Contraceptives, Postcoital / Q000191:economics* / Q000600:supply & distribution*; D017046:Cost Savings / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D003663:Decision Trees; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D004997:Ethinyl Estradiol / Q000191:economics / Q000600:supply & distribution; D005260:Female; D006266:Health Education / Q000191:economics; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D016912:Levonorgestrel / Q000191:economics / Q000600:supply & distribution; D009644:Norgestrel / Q000191:economics / Q000600:supply & distribution; D017063:Outcome Assessment, Health Care; D010593:Pharmaceutical Services / Q000191:economics* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011275:Pregnancy, Unwanted
D003281:Contraceptives, Postcoital; D009644:Norgestrel; D004997:Ethinyl Estradiol; D016912:Levonorgestrel