title: Budget impact analysis of 8 hormonal contraceptive options.
abstract: OBJECTIVE
  To develop a model comparing costs of 8 hormonal contraceptives and determine whether acquisition costs for implants and intrauterine devices (IUDs) were offset by decreased pregnancy-related costs over a 3-year time horizon from a managed care perspective.
  
  
  METHODS
  A model was developed to assess the budget impact of branded or generic oral contraceptives (OCs), quarterly intramuscular depot medroxyprogesterone, etonogestrel/ethinyl estradiol vaginal ring, etonogestrel implant, levonorgestrel IUD, norelgestromin/ethinyl estradiol transdermal contraceptive, and ethinyl estradiol/levonorgestrel extended-cycle OC.
  
  
  METHODS
  Major variables included drug costs, typical use failure rates, discontinuation rates, and pregnancy costs. The base case assessed costs for 1000 women initiating each of the hormonal contraceptives.
  
  
  RESULTS
  The etonogestrel implant and levonorgestrel IUD resulted in the fewest pregnancies, 63 and 85, respectively, and the least cost, $1.75 million and $2.0 million, respectively. In comparison, generic OC users accounted for a total of 243 pregnancies and $3.4 million in costs. At the end of year 1, costs for the etonogestrel implant ($800,471) and levonorgestrel IUD ($949,721) were already lower than those for generic OCs ($1,146,890). Sensitivity analysis showed that the cost of pregnancies, not product acquisition cost, was the primary cost driver.
  
  
  CONCLUSIONS
  Higher initial acquisition costs for the etonogestrel implant and levonorgestrel IUD were offset within 1 year by lower contraceptive failure rates and consequent pregnancy costs. Thus, after accounting for typical use failure rates of contraceptive products, the etonogestrel implant and levonorgestrel IUD emerged as the least expensive hormonal contraceptives.
authors.affiliation: Merck and Co, Inc, Whitehouse Station, NJ, USA. simone.crespi@merck.com
authors.forename: Simone
authors.initials: S
authors.lastname: Crespi
authors.forename: Matthew
authors.initials: M
authors.lastname: Kerrigan
authors.forename: Vipan
authors.initials: V
authors.lastname: Sood
mesh_terms: D000293:Adolescent; D000328:Adult; D002017:Budgets; D003270:Contraceptive Agents / Q000191:economics*; D003274:Contraceptive Devices, Female / Q000191:economics*; D003362:Cost-Benefit Analysis; D004343:Drug Implants / Q000191:economics; D005260:Female; D006801:Humans; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D014481:United States; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D004343:Drug Implants