title: Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care?
abstract: OBJECTIVE
  Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies.
  
  
  METHODS
  We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted.
  
  
  RESULTS
  For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion.
  
  
  CONCLUSIONS
  Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Jamie W
authors.initials: JW
authors.lastname: Krashin
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Nichols
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Allen
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Rodriguez
mesh_terms: D000028:Abortion, Induced / Q000191:economics / Q000331:legislation & jurisprudence*; D000328:Adult; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D035082:Federal Government; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008390:Markov Chains; D008962:Models, Theoretical; D009010:Monte Carlo Method; D009922:Oregon; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D019057:Quality-Adjusted Life Years; D013219:State Government; D013246:Sterilization, Tubal / Q000191:economics / Q000331:legislation & jurisprudence*
keywords: abortion; consent; cost-effectiveness; female sterilization; permanent contraception