title: The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives.
abstract: OBJECTIVE
  Unintended pregnancies (UPs) are associated with a significant cost burden, but the full cost burden in Canada is not known. The objectives of this study were to quantify the direct cost of UPs in Canada, the proportion of cost attributable to UPs and imperfect contraceptive adherence and the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs).
  
  
  METHODS
  A cost model was constructed to estimate the annual number and direct costs of UP in women aged 18 to 44 years. Adherence-associated UP rates were estimated using perfect- and typical-use contraceptive failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC usage. One-way sensitivity analyses were conducted to assess the impact of key variables on scenarios of increased LARC use.
  
  
  RESULTS
  There are more than 180 700 UPs annually in Canada. The associated direct cost was over $320 million. Fifty-eight percent (58%) of UPs occurred in women aged 20 to 29 years at an annual cost of $175 million; 82% of this cost ($143 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $34 million in all three switching scenarios; the largest savings ($35 million) occurred when 10% of oral contraceptive users switched to LARCs. The minimum duration of LARC usage required before cost savings was realized was 12 months.
  
  
  CONCLUSIONS
  The cost of UPs in Canada is significant and much of it can be attributed to imperfect contraceptive adherence. Increased LARC uptake may reduce contraceptive non-adherence, thereby reducing rates of UP and generating significant cost savings, particularly in women aged 20 to 29.
authors.affiliation: Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Amanda Y
authors.initials: AY
authors.lastname: Black
authors.affiliation: National Institute of Public Health of Quebec, Quebec QC; Department of Obstetrics and Gynaecology, Laval University, Quebec QC.
authors.forename: Edith
authors.initials: E
authors.lastname: Guilbert
authors.affiliation: IMS Health, London, UK.
authors.forename: Fareen
authors.initials: F
authors.lastname: Hassan
authors.affiliation: IMS Health, London, UK.
authors.forename: Ismini
authors.initials: I
authors.lastname: Chatziheofilou
authors.affiliation: IMS Health, London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Lowin
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON.
authors.forename: Mark
authors.initials: M
authors.lastname: Jeddi
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Filonenko
authors.affiliation: Office of Population Research, Princeton University, Princeton NJ; Honorary Fellow, University of Edinburgh, Edinburgh, UK.
authors.forename: James
authors.initials: J
authors.lastname: Trussell
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003267:Contraception / Q000191:economics* / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D011247:Pregnancy / Q000706:statistics & numerical data*; D049168:Pregnancy, Unplanned; D055815:Young Adult
keywords: LARC; contraceptive adherence; contraceptive efficacy; cost savings; intrauterine device; intrauterine system; long-acting reversible contraceptive; unintended pregnancy