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Tamir TT, Kassie AT, Zegeye AF. Prevalence and determinants of two or more doses of tetanus toxoid-containing vaccine immunization among pregnant women in sub-Saharan Africa: Evidence from recent demographic and health survey data. Vaccine 2023; 41:7428-7434. [PMID: 37949753 DOI: 10.1016/j.vaccine.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Tetanus is a major public health problem in low and middle income countries including in sub-Saharan Africa. Tetanus toxoid vaccine immunization during pregnancy is a global strategy against mortality due to maternal and neonatal tetanus. Recent data on tetanus toxoid-containing vaccination during pregnancy provides insight to policymakers for better implementation of the vaccine. Hence, this study aimed to determine prevalence and determinants of immunization with tetanus toxoid containing vaccine among pregnant women in sub-Saharan Africa. METHODS Secondary analysis of the recent demographic and health survey data was done using a sample of 173,032 pregnant women. Stata 14 statistical software was used for analysis and multilevel logistic regression model was applied to determine associated factors of two or more tetanus toxoid-containing vaccine immunization. P-value less than 0.05 for adjusted odds ratio was used to identify factors significantly associated with the outcome. RESULT The prevalence of immunization with two and more doses of tetanus toxoid-containing vaccine in sub-Saharan Africa was found to be 49.8 %. Women's age 36-49, women's education, poor household wealth index, unwanted pregnancy, women's occupation, husband education, and community illiteracy were significantly associated with two or more doses of tetanus toxoid-containing vaccine immunization in sub-Saharan Africa. CONCLUSION In sub-Saharan Africa, less than half of pregnant women were immunized with two or more doses of tetanus toxoid-containing vaccine. Women's education and women's employment positively affected immunization with two or more doses of tetanus toxoid-containing vaccine. Women's age group of 36-49 years, unwanted pregnancy, poor household wealth index, husbands having no formal education, and community illiteracy negatively affected receipt of two or more doses of tetanus toxoid-containing vaccine. Therefore, policymakers should take into account the determinants of tetanus toxoid immunization throughout its implementation so as to boost the coverage of tetanus toxoid immunization in sub-Saharan Africa.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lohan M, Gillespie K, Aventin Á, Gough A, Warren E, Lewis R, Buckley K, McShane T, Brennan-Wilson A, Lagdon S, Adara L, McDaid L, French R, Young H, McDowell C, Logan D, Toase S, Hunter RM, Gabrio A, Clarke M, O'Hare L, Bonell C, Bailey JV, White J. School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-139. [PMID: 37795864 DOI: 10.3310/ywxq8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Objectives To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes. Design A cluster randomised trial, incorporating health economics and process evaluations. Setting Sixty-six schools across the four nations of the UK. Participants Students aged 13-14 years. Intervention A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE. Main outcome measures Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours. Results The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83). Limitations The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01). Conclusions We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective. Future work Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings. Trial registration This trial is registered as ISRCTN10751359. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kathryn Gillespie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aisling Gough
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Lewis
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kelly Buckley
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Theresa McShane
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Susan Lagdon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Linda Adara
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca French
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Honor Young
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | | | | | - Sorcha Toase
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rachael M Hunter
- Health Economics Analysis and Research Methods Team, University College London, London, UK
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI) School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Mike Clarke
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Liam O'Hare
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - James White
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
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Swan LET, McDonald SE, Price SK. Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6487-e6499. [PMID: 36317755 PMCID: PMC10092462 DOI: 10.1111/hsc.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/19/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; Mage = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = -0.014, 95% confidence interval: -0.041, -0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.
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Affiliation(s)
- Laura E. T. Swan
- Department of Population Health SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Shelby E. McDonald
- Virginia Commonwealth UniversityClark‐Hill Institute for Positive Youth DevelopmentRichmondVirginiaUSA
| | - Sarah K. Price
- Virginia Commonwealth UniversitySchool of Social WorkRichmondVirginiaUSA
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Swan LET, McDonald SE, Price SK. Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30. [DOI: http:/doi.org/10.1111/hsc.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/16/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Laura E. T. Swan
- Department of Population Health Sciences University of Wisconsin‐Madison Madison Wisconsin USA
| | - Shelby E. McDonald
- Virginia Commonwealth University Clark‐Hill Institute for Positive Youth Development Richmond Virginia USA
| | - Sarah K. Price
- Virginia Commonwealth University School of Social Work Richmond Virginia USA
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Islam UN, Sen KK, Bari W. Living standard and access to tetanus toxoid immunization among women in Bangladesh. BMC Public Health 2022; 22:1037. [PMID: 35610604 PMCID: PMC9128149 DOI: 10.1186/s12889-022-13448-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Bangladesh has an impressive track record in the reduction of maternal and child mortality, tetanus, a dreadful disease, impedes the way to achieve Sustainable Development Goal (SDG) in this respect. Sufficient doses of tetanus toxoid containing vaccine during pregnancy ensure immunity against tetanus to mothers as well as newborns. Since inequalities persist across vaccination programs globally, in this paper, an attempt has been made to examine whether tetanus toxoid immunization (TTI) status among the women of reproductive age in Bangladesh for their most recent live birth born preceding 2 years of the survey changes with their living standard index (LSI). METHODS Five domains of deprivation such as energy use, improved sanitation, drinking water, housing and assets ownership were used to compute the LSI using a approach proposed by Alkire and Foster. The adjusted association between LSI and TTI was established by using logistic regression model. For the purpose of statistical analysis, a nationally representative cross-sectional data extracted from Bangladesh Multiple Indicator Cluster Survey (BMICS), 2019 have been used. RESULT The bivariate analysis revealed that 79.5% (95% CI 78.0-81.0) of women with low and 83.1% (95% CI 81.3-84.9) with moderate living standards had sufficient vaccination coverage for their most recent pregnancies while this percentage was higher for the women who belonged to high living standard (85.2, 95% CI = 84.2-86.2). A strong evidence for greater odds of sufficient immunization with TT among the women maintaining a high standard of living (AOR = 1.24, 95% CI = 1.08-1.42, p < 0.01) was found from regression analysis. CONCLUSION The results depict existing living standard disparity with respect to TT vaccination coverage among women in Bangladesh. Present research suggests that immunization campaigns need to be conducted especially for the disadvantaged people to improve their health care and immunization service utilization among women within the age bracket of 15 to 49. This study proposed a scientific way to enhance TT vaccination among Bangladeshi women, which could help Bangladesh attain a widespread tetanus protection and thus, meet the SDGs for maternal and child mortality reduction.
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Affiliation(s)
| | - Kanchan Kumar Sen
- Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
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Abel L, Quaife M. A Pregnant Pause: Rethinking Economic Evaluation in Contraception and Pregnancy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:32-35. [PMID: 35031097 DOI: 10.1016/j.jval.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 06/14/2023]
Abstract
Pregnancy presents a unique challenge to economic evaluation, requiring methods that can account for both maternal and fetal outcomes. The ethical challenges to healthcare presented by pregnancy are well understood, but these have not yet been incorporated into cost-effectiveness approaches. Economic evaluations of pregnancy currently take an ad hoc approach to outcome valuation, opening the door to biased estimates and inconsistent resource allocation. We summarize the limitations of current economic evaluation methods and outline key areas for future work.
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Affiliation(s)
- Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK.
| | - Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK
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Lewandowska M, De Abreu Lourenco R, Haas M, Watson CJ, Black KI, Taft A, Lucke J, McGeechan K, McNamee K, Peipert JF, Mazza D. Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia. AUST HEALTH REV 2021; 45:728-734. [PMID: 34903325 DOI: 10.1071/ah20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial results were extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancy-related healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. What is known about the topic? The uptake of long-active reversible contraceptives (LARC) in Australia is low. The ACCORd trial assessed the efficacy of providing structured training to general practitioners (GPs) on LARC counselling, together with access to rapid referral to insertion clinics. What does this paper add? This study is the first to assess the cost-effectiveness of a complex intervention in the general practice setting aimed at increasing the uptake of LARC in Australia. What are the implications for practitioners? The results show that implementing a complex intervention in general practice involving GP education and the availability of rapid referral to LARC insertion clinics is a cost-effective approach to increase LARC use and its attending efficacy. If the majority of Australian GPs were able to deliver effectiveness-based contraceptive counselling and either insert LARC or use a rapid referral process to a LARC insertion clinic, the additional cost associated with the purchase of LARC products and their insertion would be offset by reductions to health system costs as a result of fewer UPB and abortions. Moreover, the benefits to women's physical and psychological health of avoiding such events is substantial.
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Affiliation(s)
- Milena Lewandowska
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and Corresponding author.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ;
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Cathy J Watson
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
| | - Kirsten I Black
- Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia.
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.
| | - Kevin McGeechan
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Kathleen McNamee
- Family Planning Victoria, Vic., Australia. ; and Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Vic., Australia
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
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The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019. Sci Rep 2021; 11:23740. [PMID: 34887462 PMCID: PMC8660789 DOI: 10.1038/s41598-021-03096-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022] Open
Abstract
To describe the prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa. A cross-sectional survey was conducted between October and mid-November 2019 among pregnant women aged 15–49 years in 1589 selected public antenatal care facilities. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy. Survey logistic regression examined factors associated with unintended pregnancy. Among 34,946 participants, 51.6% had an unintended pregnancy. On multivariable analysis, the odds of unintended pregnancy was higher among women who knew their HIV-positive status before pregnancy but initiated treatment after the first antenatal visit (adjusted odds ratio [aOR], 1.5 [95% confidence interval (CI):1.2–1.8]), women who initiated treatment before pregnancy (aOR, 1.3 [95% CI:1.2–1.3]), and women with a new HIV diagnosis during pregnancy (aOR, 1.2 [95% CI:1.1–1.3]) compared to HIV-negative women. Women who were single, in a non-cohabiting or a cohabiting relationship, and young women (15–24 years) had significantly higher risk of unintended pregnancy compared to married women and women aged 30–49 years, respectively. A comprehensive approach, including regular assessment of HIV clients’ pregnancy intention, and adolescent and youth-friendly reproductive health services could help prevent unintended pregnancy.
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Chatroux L, Darney BG, Skye M, Caughey AB, Rodriguez MI. Examining the effect of unintended pregnancy on health utility using four measures. Contraception 2021; 104:344-349. [PMID: 33939984 DOI: 10.1016/j.contraception.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We measured women's preferences for avoiding an unintended pregnancy. We determined if young age (<25) was associated with lowest utility with an unintended pregnancy. STUDY DESIGN We conducted a cross sectional study of women presenting for hormonal contraception who did not desire a pregnancy. We used four techniques to elicit health prefences and calculate utilities for an unintended pregnancy: visual analog scale, and willingness to pay, time-tradeoff (TTO), and standard gamble. We dichotomized each measure to define lowest utility for each measure. We used predicted probabilities and multivariable logistic regression to estimate the association between age (≤25 vs ≥26 y) and lowest utility with an unintended pregnancy. RESULTS Our sample included 419 participants from four states. We found that younger age (≤25) was positively associated with reporting the lowest utility for unintended pregnancy. In absolute terms, with the visual analog scale, the probability that a woman 25 years or younger would have lower preference for an unintended pregnancy was 26.8% (95% CI 20.4-33.2%) versus (21.7% (95% CI 14.3-29.0%). Using the willingness to pay, the probability of the younger group having lower preference was 84.9% (CI 80.3-89.4%) compared to 57.3% (CI 49.3-65.3). With the TTO, Women 25 years old and younger had a 78.3% probability (CI 72.6-84.0%) of low utility on the TTO vs 48.9% (CI 40.9-56.9%) in the older group. With standard gamble, younger women had a 47.0% probability (CI 36.8-50.6%) versus 18.0% (CI 14.7-27.5%). CONCLUSIONS Women of all ages report a decrease in health utility with unintended pregnancy. This decrease in health utility is greater among young women (age <25). IMPLICATIONS Health utilities for unintended pregnancy can be used to guide cost effectiveness research and health policy.
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Affiliation(s)
- Louisa Chatroux
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Megan Skye
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, United States.
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White A, Srinivasan M, Wingate LM, Peasah S, Fleming M. Development of a pharmacoeconomic registry: an example using hormonal contraceptives. HEALTH ECONOMICS REVIEW 2021; 11:10. [PMID: 33745016 PMCID: PMC7981865 DOI: 10.1186/s13561-021-00309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Disease-specific registries, documenting costs and probabilities from pharmacoeconomic studies along with health state utility values from quality-of-life studies could serve as a resource to guide researchers in evaluating the published literature and in the conduct of future economic evaluations for their own research. Registries cataloging economic evaluations currently exist, however they are restricted by the type of economic evaluations they include. There is a need for intervention-specific registries, that document all types of complete and partial economic evaluations and auxiliary information such as quality of life studies. The objective of this study is to describe the development of a pharmacoeconomic registry and provide best practices using an example of hormonal contraceptives. METHODS An expert panel consisting of researchers with expertise in pharmacoeconomics and outcomes research was convened and the clinical focus of the registry was finalized after extensive discussion. A list of key continuous, categorical and descriptive variables was developed to capture all relevant data with each variable defined in a data dictionary. A web-based data collection tool was designed to capture and store the resulting metadata. A keyword based search strategy was developed to retrieve the published sources of literature. Finally, articles were screened for relevancy and data was extracted to populate the registry. Expert opinions were taken from the panel at each stage to arrive at consensus and ensure validity of the registry. RESULTS The registry focused on economic evaluation literature of hormonal contraceptives used for contraception. The registry consisted of 65 articles comprising of 22 cost-effectiveness analyses, 9 cost-utility analyses, 7 cost-benefit analyses, 1 cost-minimization, 14 cost analyses, 10 cost of illness studies and 2 quality of life studies. The best practices followed in the development of the registry were summarized as recommendations. The completed registry, data dictionary and associated data files can be accessed in the supplementary information files. CONCLUSION This registry is a comprehensive database of economic evaluations, including costs, clinical probabilities and health-state utility estimates. The collated data captured from published information in this registry can be used to identify trends in the literature, conduct systematic reviews and meta-analysis and develop novel pharmacoeconomic models.
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Affiliation(s)
- Annesha White
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
- Department of Pharmacotherapy, UNT System College of Pharmacy, 3500 Camp Bowie Blvd, IREB 211, Fort Worth, TX 76107 USA
| | - Meenakshi Srinivasan
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
| | | | - Samuel Peasah
- Mercer University College of Pharmacy, Atlanta, GA 30341 USA
| | - Marc Fleming
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
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Hajizadeh M, Nghiem S. Does unwanted pregnancy lead to adverse health and healthcare utilization for mother and child? Evidence from low- and middle-income countries. Int J Public Health 2020; 65:457-468. [PMID: 32270238 PMCID: PMC7275006 DOI: 10.1007/s00038-020-01358-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Unwanted pregnancy is an important public health concern in low- and middle-income countries (LMICs). Using a pooled dataset from 48 Demographic Health Surveys conducted in Africa, Asia, Latin America and Europe (n = 494,778), we examined the effect of unwanted pregnancy on maternal and child healthcare utilization and child health outcomes in LMICs. METHODS We used logistic regression models to estimate the effect of unwanted pregnancy on antenatal care use, supervised delivery, childhood vaccination and three indicators of child health, viz. stunting (height-for-age), underweight (weight-for-age) and wasting (weight-for-height). RESULTS We found that mothers of children whose pregnancies had been unwanted had a lower probability of attending four or more antenatal care visits by 3.6% (95% confidence interval = 1.9-5.4%) compared to those whose pregnancy was wanted. We did not find significant impacts of unwanted pregnancy on supervised delivery, childhood vaccination uptake or child health indicators. CONCLUSIONS Birth characteristics, household-level determinants and country-level characteristics seem to be more closely related to maternal and child healthcare utilization as well as child health outcomes than whether the pregnancy was wanted or unwanted in LMICs.
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Affiliation(s)
- Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada.
| | - Son Nghiem
- The Centre for Applied Health Economics, Griffith University, Brisbane, Australia
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Sundstrom B, Billings D, Smith E, Ferrara M, Albert B, Suellentrop K. Evaluating the Whoops Proof S.C. Campaign: A Pair-Matched Group Pretest–Posttest Quasi-experimental Study. Matern Child Health J 2019; 23:1036-1047. [DOI: 10.1007/s10995-018-02729-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Olakunde BO, Sam-Agudu NA, Patel TY, Hunt AT, Buffington AM, Phebus TD, Onwasigwe E, Ezeanolue EE. Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators. Contraception 2019; 99:205-211. [PMID: 30685286 DOI: 10.1016/j.contraception.2018.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa. STUDY DESIGN We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model. RESULTS We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level). CONCLUSIONS Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.
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Affiliation(s)
- Babayemi O Olakunde
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tanviben Y Patel
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T Hunt
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aurora M Buffington
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA; University of Nevada Cooperative Extension, Las Vegas, NV, USA
| | - Tara D Phebus
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | | | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria; HealthySunrise Foundation, Las Vegas, NV, USA
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Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery. Am J Obstet Gynecol 2019; 220:106.e1-106.e10. [PMID: 30170036 DOI: 10.1016/j.ajog.2018.08.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Removal of the fallopian tubes at the time of hysterectomy or interval sterilization has become routine practice to prevent ovarian cancer. While emerging as a strategy, uptake of this procedure at the time of cesarean delivery for pregnant women seeking permanent sterilization has not been widely adopted due to perceptions of increased morbidity and operative difficulty with a lack of available data in this setting. OBJECTIVE We sought to conduct a cost-effectiveness analysis comparing strategies for long-term sterilization and ovarian cancer risk reduction at the time of cesarean delivery, including bilateral tubal ligation, opportunistic salpingectomy, and long-acting reversible contraception. STUDY DESIGN A decision-analytic and cost-effectiveness model was constructed for pregnant women undergoing cesarean delivery who desired permanent sterilization in the US population, comparing 3 strategies: (1) bilateral tubal ligation, (2) bilateral opportunistic salpingectomy, and (3) postpartum long-acting reversible contraception. This theoretic cohort consisted of 110,000 pregnant women desiring permanent sterilization at the time of cesarean delivery and ovarian cancer prevention at an average of 35 years who were monitored for an additional 40 years based on an average US female life expectancy of 75 years. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured as quality-adjusted life years. Secondary outcomes included: the number of ovarian cancer cases and deaths, procedure-related complications, and unintended and ectopic pregnancies. The 1-, 2-, and 3-way and Monte Carlo probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set at $100,000. RESULTS Both bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery have favorable cost-effectiveness ratios. In the base case analysis, salpingectomy was more cost-effective with an incremental cost-effectiveness ratio of $23,189 per quality-adjusted life year compared to tubal ligation. Long-acting reversible contraception after cesarean was not cost-effective (ie, dominated). Although salpingectomy and tubal ligation were both cost-effective over a wide range of cost and risk estimates, the incremental cost-effectiveness ratio analysis was highly sensitive to the uncertainty around the estimates of salpingectomy cancer risk reduction, risk of perioperative complications, and cost. Monte Carlo probabilistic sensitivity analysis estimated that tubal ligation had a 49% chance of being the preferred strategy over salpingectomy. If the true salpingectomy risk of perioperative complications is >2% higher than tubal ligation or if the cancer risk reduction of salpingectomy is <52%, then tubal ligation is the preferred, more cost-effective strategy. CONCLUSION Bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery are both cost-effective strategies for permanent sterilization and ovarian cancer risk reduction. Although salpingectomy and tubal ligation are both reasonable strategies for cesarean patients seeking permanent sterilization and cancer risk reduction, threshold analyses indicate that the risks and benefits of salpingectomy with cesarean delivery need to be better defined before a preferred strategy can be determined.
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Subramaniam A, Einerson BD, Blanchard CT, Erickson BK, Szychowski J, Leath CA, Biggio JR, Huh WK. The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction. Gynecol Oncol 2019; 152:127-132. [PMID: 30477808 PMCID: PMC6321779 DOI: 10.1016/j.ygyno.2018.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Opportunistic salpingectomy is a cost-effective strategy recommended for ovarian cancer (OvCa) risk reduction at the time of gynecologic surgery in women who have completed childbearing. We aimed to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation (TL) during cesarean delivery. STUDY DESIGN A cost-effectiveness analysis using decision modeling to compare opportunistic salpingectomy to TL at the time of cesarean using probabilities of procedure completion derived from a trial. Probability and cost inputs were derived from local data and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2017 U.S. dollars per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. One- and two-way sensitivity analyses were performed for all variables. A probabilistic sensitivity analysis determined the proportion of simulations in which each strategy would be cost-effective. RESULTS Opportunistic salpingectomy was cost-effective compared to TL with an ICER of $26,616 per QALY. In 10,000 women desiring sterilization with cesarean, opportunistic salpingectomy would result in 17 fewer OvCa diagnoses, 13 fewer OvCa deaths, and 25 fewer unintended pregnancies compared to TL - with an associated cost increase of $4.7 million. The model was sensitive only to OvCa risk reduction from salpingectomy and TL. Opportunistic salpingectomy was not cost-effective if its cost was >$3163.74 more than TL, if the risk-reduction of salpingectomy was <41%, or if the risk-reduction of TL was >46%. In probabilistic sensitivity analysis opportunistic salpingectomy was cost effective in 75% of simulations. CONCLUSIONS In women undergoing cesarean with sterilization, opportunistic salpingectomy is likely cost-effective and may be cost-saving in comparison to TL for OvCa risk reduction.
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Affiliation(s)
- Akila Subramaniam
- University of Alabama at Birmingham, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, United States of America.
| | - Brett D Einerson
- University of Utah, Division of Maternal-Fetal Medicine, Salt Lake City, UT, United States of America
| | - Christina T Blanchard
- University of Alabama at Birmingham, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, United States of America
| | - Britt K Erickson
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN, United States of America
| | - Jeff Szychowski
- University of Alabama at Birmingham, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, United States of America
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
| | - Joseph R Biggio
- Ochsner Health System, New Orleans, LA, United States of America
| | - Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL, United States of America
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Madden T, Barker AR, Huntzberry K, Secura GM, Peipert JF, McBride TD. Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis. Am J Obstet Gynecol 2018; 219:595.e1-595.e11. [PMID: 30194049 DOI: 10.1016/j.ajog.2018.08.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/25/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. OBJECTIVE The purpose of this study was to conduct a cost-savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. STUDY DESIGN The Contraceptive CHOICE Project was a prospective cohort study of 9256 reproductive-age women who were enrolled between 2007 and 2011. Study follow-up was completed October 2013. This analysis includes 5061 Contraceptive CHOICE Project participants who were current Missouri Medicaid beneficiaries or were uninsured and reported household incomes <201% of the federal poverty line. We created a simulated comparison group of women who were receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the Contraceptive CHOICE Project. Data about contraceptive use for the comparison group (N=5061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison that would account for the difference in the 2 populations, we used our simulation model to estimate total Contraceptive CHOICE Project costs and total comparison group costs. We reported all costs in 2013 dollars to account for inflation. RESULTS Among the Contraceptive CHOICE Project participants who were included, the uptake of intrauterine devices and implants was 76.1% compared with 4.8% among the comparison group. The estimated contraceptive cost for the simulated Contraceptive CHOICE Project group was $4.0 million vs $2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated Contraceptive CHOICE Project group compared with the comparison group were 927 and 483, respectively, which represented a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the Contraceptive CHOICE Project was $5.0 million (40.7%) over the project duration. CONCLUSION A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.
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Lynch M, De Abreu Lourenco R, Flattery M, Haas M. Reviewing the cost-effectiveness of long-acting reversible contraceptive methods in an Australian context. Aust N Z J Obstet Gynaecol 2018; 59:21-35. [PMID: 30311634 DOI: 10.1111/ajo.12906] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Relative to the oral contraceptive pill, uptake of long-acting reversible contraceptive methods (LARCs) in Australia continues to be lower than might be suggested by the evidence on their clinical and economic benefits. AIM To undertake a critical appraisal of published economic evaluations of LARCs to assess the generalisability of their results to the Australian healthcare context. MATERIALS AND METHODS A search of the literature was conducted to identify studies of economic evaluations of LARCs using the Medline, Embase and PubMed databases. The quality of the studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS A total of 1009 citations were screened, from which 20 papers, typically reporting the cost per pregnancy avoided, were reviewed. The overall quality of the studies varied but was generally poor (average score of 62/100). To aid comparisons, results have been grouped under the headings IUS (all hormonal intrauterine systems), IUDs (all non-hormonal intrauterine devices), injectables (all contraceptive injections) and implants (all subdermal contraceptive implants). Overall, the results indicated that LARCs were more effective and less costly than oral contraceptives. CONCLUSIONS Despite evidence that LARCs represent value for money, limitations in study quality and approaches must be taken into account when applying these results to Australia. Differences in healthcare settings aside, LARCs may also have benefits beyond their effect on pregnancy that might be captured in broader analyses, such as cost-benefit analyses using willingness to pay methods. These would capture benefits beyond health, which seem to be particularly relevant to contraception.
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Affiliation(s)
- Matthew Lynch
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Martin Flattery
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Use of modern contraceptive methods and its association with QOL among Nepalese female migrants living in Japan. PLoS One 2018; 13:e0197243. [PMID: 29768459 PMCID: PMC5955577 DOI: 10.1371/journal.pone.0197243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/28/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Modern contraceptive use among migrants may be limited due to factors such as language barriers, socio-economic condition, and inadequate knowledge. Limited evidence is available on the factors associated with the use of modern contraceptive methods by migrants in Japan. Moreover, evidence remains scarce on the quality of life (QOL) of migrants in relation to contraceptive use. As the Nepalese migrant population in Japan is increasing, this study was conducted to address their sexual and reproductive health issues. Therefore, the objectives of this study were to examine the factors associated with the use of modern contraceptive methods and to explore the association between the use of modern contraceptive methods and QOL among married Nepalese female migrants in Japan. Methods This is a cross-sectional study conducted among 189 married Nepalese female migrants residing in five prefectures of Japan from August to October 2016. This study employed snowball sampling to recruit the migrants. Simple and multiple logistic analyses were used to examine the association between independent variables and the use of modern contraceptive methods. Similarly, multiple linear regression analysis was used to examine the association between the use of modern contraceptive methods and quality of life. Results Migrants who had higher knowledge of modern contraceptive methods were more likely to use them (Adjusted Odds Ratio [AOR] = 1.31; 95% Confidence Interval [CI]: 1.07, 1.60). The psychological domain scores were higher in those who used modern contraceptive methods (Coefficient [B] = 0.58; 95% CI: 0.05, 1.11). Conclusion This study highlights the importance of the knowledge of modern contraceptive methods to increase their use. Also, the use of modern contraceptive methods improves the psychological QOL domain scores of the migrants using them. These results suggest a need for sexual and reproductive health education for migrants, especially pertaining to modern contraceptive use.
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Lundsberg LS, Xu X, Schwarz EB, Gariepy AM. Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women. Contraception 2017; 96:411-419. [PMID: 28823842 PMCID: PMC6267929 DOI: 10.1016/j.contraception.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts. STUDY DESIGN Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014-June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics. RESULTS Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28-0.91), PROMIS GSF-derived utility (0.66-0.75), SG (0.985-1.00) or TTO (0.9990-0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts. CONCLUSIONS Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts. IMPLICATIONS Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Eleanor B Schwarz
- Department of Internal Medicine, University of California Davis, Davis, CA
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Kazemi F, Nahidi F, Kariman N. Exploring factors behind pregnant women's quality of life in Iran: a qualitative study. Electron Physician 2017; 9:5991-6001. [PMID: 29560152 PMCID: PMC5843426 DOI: 10.19082/5991] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/11/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pregnancy-related physiologic and psychosocial alterations can impact on the body and cause symptoms which may affect quality of life. Since qualitative studies can provide more in-depth understanding of quality of life and its determining factors, this study was conducted with the aim of exploring factors affecting pregnant women's quality of life. METHODS A qualitative descriptive study with conventional content analysis approach was made using the conventional content analysis approach on a purposeful sample of sixteen pregnant Iranian women in Hamadan, Iran from May 2015 to December 2015. Sampling was continued until data saturation. Data were collected through in-depth semi-structured personal interviews, and were analyzed using the conventional content analysis approach. RESULTS Data analysis resulted in three main categories, namely, the effects of pregnancy on different aspects of health (including psychological disorders, impaired interactions, disturbances in doing daily activities, disturbed body image, alterations in sexual relationships, physical disorders, and alterations in dietary habits and treatment regimens), pregnancy-related concerns (regarding the gender of the fetus, financial problems, childbirth, health, and the future), and coping with pregnancy (through strategies such as spirituality, positive attitude toward pregnancy, distraction and imagination, and support). CONCLUSIONS This study showed that different factors can affect pregnant women's quality of life. Nonetheless, prenatal care services are mainly focused on pregnancy-related physical problems, and other aspects of care are usually taken for granted. Consequently, healthcare professionals need to pay greater attention to pregnant women's quality of life and its contributing factors.
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Affiliation(s)
- Farideh Kazemi
- Ph.D. Candidate of Reproductive Health, Department of Midwifery & Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nahidi
- Ph.D. of Health Education and Promotion, Assistant Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery & Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Ph.D. of Reproductive Health, Assistant Professor, Department of Midwifery & Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Unintended pregnancy is a public health problem with societal consequences. The Contraceptive CHOICE Project (CHOICE) demonstrated a reduction in teen pregnancy and abortion by removing barriers to effective contraception. The purpose of the study was to describe the dissemination approach used to create awareness of and promote desire to adopt the CHOICE model among selected audiences. We used a 4-stage approach and detail the work completed in the first 2 stages. We describe stakeholder involvement in the first stage and the process of undertaking core strategies in the second stage. We examine insights gained throughout the process. Through our dissemination approach, we reached an estimated 300,000 targeted individuals, not including the population reached through media. We were contacted by 141 entities for technical assistance. The completion and reporting of dissemination processes is an important component of research. There is a need to fully document and disseminate strategies that can help facilitate practice change.
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Dilley SE, Havrilesky LJ, Bakkum-Gamez J, Cohn DE, Michael Straughn J, Caughey AB, Rodriguez MI. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol 2017; 146:373-379. [PMID: 28577884 DOI: 10.1016/j.ygyno.2017.05.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. METHODS We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. RESULTS In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. CONCLUSIONS Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.
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Affiliation(s)
- Sarah E Dilley
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, 20 Duke Medicine Cir, Durham, NC 27710, United States.
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st Ave SW, Rochester, MN 55902, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, 456 W 10th Ave, Columbus, OH 43210, United States.
| | - J Michael Straughn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S., Rm 10250, Birmingham, AL 35233, United States.
| | - Aaron B Caughey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
| | - Maria I Rodriguez
- Section of Family Planning, Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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Gariepy A, Lundsberg LS, Vilardo N, Stanwood N, Yonkers K, Schwarz EB. Pregnancy context and women's health-related quality of life. Contraception 2017; 95:491-499. [PMID: 28188745 PMCID: PMC5466832 DOI: 10.1016/j.contraception.2017.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to quantify the association of pregnancy context and health-related quality of life (HRQoL). STUDY DESIGN English- or Spanish-speaking women, aged 16-44, with pregnancies <24 weeks' gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy "context," including timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form. Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables. RESULTS We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic; 37% Black, non-Hispanic; and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL. CONCLUSIONS After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL. IMPLICATIONS The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.
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Affiliation(s)
- Aileen Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Nicole Vilardo
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Nancy Stanwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Kimberly Yonkers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Eleanor B Schwarz
- Department of Internal Medicine, University of California, Davis, CA
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Health state utility, willingness to pay, and quality of life among Taiwanese patients with psoriasis. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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KONISHI S, TAMAKI E. Pregnancy intention and contraceptive use among married and unmarried women in Japan. ACTA ACUST UNITED AC 2016. [DOI: 10.3861/jshhe.82.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shoko KONISHI
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo
- Department of Anthropology, University of Washington
| | - Emi TAMAKI
- College of Social Sciences, Ritsumeikan University
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Schmid R. The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France. PLoS One 2015; 10:e0138990. [PMID: 26422259 PMCID: PMC4589416 DOI: 10.1371/journal.pone.0138990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 09/07/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. METHODS The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. RESULTS The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. CONCLUSIONS Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors.
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Investigating the association between pregnancy intention and insecticide-treated bed net (ITN) use: a cross-sectional study of pregnant women in Rwanda. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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28
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Henry N, Hawes C, Lowin J, Lekander I, Filonenko A, Kallner HK. Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden. Acta Obstet Gynecol Scand 2015; 94:884-90. [PMID: 26015090 PMCID: PMC4744785 DOI: 10.1111/aogs.12679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 05/05/2015] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the cost‐effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy. Design Cost‐effectiveness model using efficacy and discontinuation data from published articles. Setting Societal perspective including direct and indirect costs. Population Women at risk of unintended pregnancy using reversible contraception. Methods An economic analysis was conducted by modeling the different health states of women using contraception over a 3‐year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching. Main outcome measures Cost‐effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality‐adjusted life‐year was calculated. Results Levonorgestrel intrauterine system 13.5 mg generated costs savings of €311 000 in a cohort of 1000 women aged 15–44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception. Conclusion Levonorgestrel intrauterine system 13.5 mg is a cost‐effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long‐acting reversible contraception methods could result in fewer unintended pregnancies, quality‐adjusted life‐year gains, as well as cost savings.
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Affiliation(s)
| | | | | | | | | | - Helena K Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Hendrie CA, Brewer G, Lewis H, Mills F. Contemporary and historical evidence to suggest that women's preference for age at birth of first child remains consistent across time. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1373-1378. [PMID: 24696388 DOI: 10.1007/s10508-014-0290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 11/12/2013] [Accepted: 01/11/2014] [Indexed: 06/03/2023]
Abstract
Women's ability to reproduce is restricted by menarche and menopause. First children are, however, not typically born until some years after the onset of puberty. Other factors therefore contribute towards this delay. In this context, women's hips do not reach full adult form until they are in their mid-20s. Therefore, physiological and morphological factors appear to determine an optimum age-range for reproduction. The following studies were conducted in order to investigate this hypothesis. Study 1 asked nulliparous women questions about ages at which particular life events related to reproduction should ideally occur. This revealed their preferred age at birth of first child to be approximately 27 years old. Study 2 replicated these findings and further showed that women with children actually had their first child at a very similar age (27.93 [±0.79]). Findings from Study 3 were also remarkably consistent (28.15 [±0.39]). Study 4 examined the 1901 U.K. Census record and incorporated an analysis of the influence of wealth. Middle class women were on average 24.88 (±0.22) years old at the birth of their first child. Poor women were on average 23.50 (±0.20) years old. These figures at least approximate to findings from Studies 1-3, which is noteworthy given that modern contraceptive methods were not widely available at the time. It is concluded that female strategies to delay giving birth to their first child until they are of an age that approaches or coincides with their full hip maturation are enduring across time.
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Affiliation(s)
- Colin A Hendrie
- Institute of Psychological Sciences, University of Leeds, Leeds, West Yorkshire, LS2 9JT, UK,
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Le HH, Connolly MP, Bahamondes L, Cecatti JG, Yu J, Hu HX. The burden of unintended pregnancies in Brazil: a social and public health system cost analysis. Int J Womens Health 2014; 6:663-70. [PMID: 25075201 PMCID: PMC4106956 DOI: 10.2147/ijwh.s61543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Unintended pregnancy (UP) is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010. Methods The consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$]) within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources. Results We estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3%) attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8%) and R$4.07 billion (99.2%) attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%), with labor and delivery responsible for most costs (R$988 million; 24.3%) for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3%) with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%). Based on the national cost, we estimate the cost per UP to be R$2,293. Conclusion Despite weaknesses in precise estimates in annual pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality.
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Affiliation(s)
- Hoa H Le
- Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands
| | - Mark P Connolly
- Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands ; Global Market Access Solutions, Saint-Prex, Switzerland
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jingbo Yu
- Merck & Co, Whitehouse Station, NJ, USA
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Krashin JW, Edelman AB, Nichols MD, Allen AJ, Caughey AB, Rodriguez MI. Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care? Am J Obstet Gynecol 2014; 211:76.e1-76.e10. [PMID: 24799310 DOI: 10.1016/j.ajog.2014.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/15/2014] [Accepted: 04/30/2014] [Indexed: 11/17/2022]
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. STUDY DESIGN 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. CONCLUSION Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs.
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Affiliation(s)
- Jamie W Krashin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Alison B Edelman
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Mark D Nichols
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Allison J Allen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
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He H, Blum RW. Prevalence of unintended pregnancy and its associated factors among sexually active never-married youth in Shanghai. J Paediatr Child Health 2013; 49:912-918. [PMID: 24168718 DOI: 10.1111/jpc.12426] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/28/2022]
Abstract
AIMS This study was conducted to determine the prevalence and the associated factors for unintended pregnancy among never-married sexually active youth (15-24 years old) in Shanghai. METHODS Using a probability sample (n = 765, including 502 males and 263 females) from 2006, we estimated prevalence of unintended pregnancy involvement for females and males by demographic factors and its associations with contextual and behavioural factors, guided by a social-ecological framework. RESULTS Weighted proportion analyses estimated that 13.8% of females and 17.7% of males had been involved in an unintended pregnancy, and 99.0% and 90.5% of such pregnancies were reported to have ended in abortion by females and males, respectively. Controlling for sexual behaviour factors and residence history, multivariate hazard analyses with Weibull functions found increased hazard among older female youth (19-21 vs. 15-18 years old) but decreased hazard among older male youth (15-18 vs. 19-21/22-24 years old) as compared with the younger groups. Parallel analyses of unintended pregnancy's associations with contextual factors by sex also suggested that female unintended pregnancy involvement was more likely to be associated with family factors (family living arrangements and maternal education), while unintended pregnancy involvement among males was only associated with school factors (school climate and sex education on pregnancy) and perceived neighbourhood contraceptive services access. CONCLUSIONS Sexually active and never-married youth are at considerable risk of unintended pregnancy and abortion in Shanghai. Age- and sex-specific strategies will be needed if China is going to be successful in addressing unintended pregnancy.
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Affiliation(s)
- Huan He
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert W Blum
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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Burlone S, Edelman AB, Caughey AB, Trussell J, Dantas S, Rodriguez MI. Extending contraceptive coverage under the Affordable Care Act saves public funds. Contraception 2013; 87:143-8. [PMID: 22840280 PMCID: PMC5515367 DOI: 10.1016/j.contraception.2012.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 06/08/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) will expand health care coverage to low-income Americans. Contraception services are a mandated component of ACA plans. STUDY DESIGN A decision-analytic model was developed to compare the costs and outcomes of the current versus the proposed plan for contraceptive coverage (Federal Poverty Level=185% vs. 399%, respectively) over 5 years. The perspective adopted was that of Oregon state insurance providers. The primary outcomes were number of pregnancies averted, health costs and quality adjusted life years (QALYs). Contraceptive failure rates, costs, projected insurance coverage, contraception use and pregnancy outcome data were obtained from the published literature. Sensitivity analyses were performed for all variables. RESULTS Extending contraceptive coverage both saves money and improves outcomes for Oregon state insurance plan providers. The proposed policy would prevent an additional 72 pregnancies per 1000 women over 5 years. Extending coverage is cost-effective, saving an additional $489 per woman enrolled over 5 years while increasing QALYs. CONCLUSIONS Expanding contraceptive coverage under the Affordable Health Act is cost-effective for Oregon state insurance providers.
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Affiliation(s)
- Suzanne Burlone
- Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR 97239, USA.
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The price of emergency contraception in the United States: what is the cost-effectiveness of ulipristal acetate versus single-dose levonorgestrel? Contraception 2012; 87:385-90. [PMID: 23040122 DOI: 10.1016/j.contraception.2012.08.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/10/2012] [Accepted: 08/24/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ulipristal acetate (UPA) is a novel form of emergency contraception (EC) that appears to be more effective than the prevailing method, single-dose levonorgestrel (LNG). This study examines the cost-efficacy of UPA compared with LNG. STUDY DESIGN A decision-analytic model was developed to compare the cost-effectiveness of UPA versus LNG in preventing unintended pregnancy when taken within 120 h of unprotected intercourse. Univariate and bivariate sensitivity analyses, as well as Monte Carlo simulation and threshold analyses, were performed. RESULTS Utilizing UPA instead of LNG would result in 37,589 fewer unintended pregnancies per 4,176,572 estimated US annual EC uses (UPA 54,295 pregnancies; LNG 91,884 pregnancies) and a societal savings of $116.3 million annually. Cost-effectiveness acceptability curve analyses suggest a 96% probability that UPA is more cost-effective at a willingness to pay $100,000 per quality-adjusted life year. CONCLUSIONS UPA is cost-effective in preventing unintended pregnancy after unprotected intercourse. Efforts should be promoted to increase access to UPA.
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Finnell SME, Carroll AE, Downs SM. The utility assessment method order influences measurement of parents' risk attitude. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:926-32. [PMID: 22999143 DOI: 10.1016/j.jval.2012.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/09/2012] [Accepted: 04/08/2012] [Indexed: 05/21/2023]
Abstract
BACKGROUND Standard gamble (SG) and time trade-off (TTO) are two methods used for obtaining health utility values (utilities). Whether the order in which the methods are applied alters the relative utilities obtained by each method is unknown. OBJECTIVE We sought to determine whether the order in which SG and TTO utilities were obtained affects the relative values of the utilities obtained by each technique. METHODS Utilities were assessed for 29 health states from 4016 parents by using SG and TTO. The assessment order was randomized by respondent. For analysis by health state, we calculated (SG - TTO) for each assessment and tested whether the SG - TTO difference was significantly different between the two groups (SG first and TTO first). For analysis by individual, we calculated a risk-posture coefficient, γ, defined by the utility curve, SG = TTO(γ). We predicted γ through regression analysis with the covariates: child age, child sex, birth order, respondent age, respondent education level, and assessment method order. RESULTS In 19 of 29 health states, the SG - TTO difference was significantly greater (more risk averse) when TTO was assessed first. In the regression analysis, "child age" and "assessment method order" were significant predictors of risk attitude. The risk posture coefficient γ was higher (more risk-seeking) with increasing child age and in the SG-first respondents. CONCLUSION The order in which the SG versus TTO method is used strongly influences the relative values of the utilities obtained.
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Affiliation(s)
- S Maria E Finnell
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Williams SL, Parisi SM, Hess R, Schwarz EB. Associations between recent contraceptive use and quality of life among women. Contraception 2011; 85:282-7. [PMID: 22067760 DOI: 10.1016/j.contraception.2011.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Whether contraception affects health-related quality of life (HRQoL) is unclear. STUDY DESIGN We conducted a cross-sectional analysis of routine intake data collected from women aged 18-50 years, including the RAND-36 (Research and Development Corporation) measure of HRQoL, pregnancy intentions and recent contraceptive use. We used multivariable logistic regression to test the relationship between HRQoL and use of any and specific contraceptives. Physical and mental HRQoLs were dichotomized based on US population averages. Models were adjusted for age, race, marital status, education and pregnancy intentions. RESULTS Among the 726 women, those using any form of contraception were more likely to have average or better mental HRQoL than women using no contraception [adjusted odds ratio (aOR)=1.60, 95% confidence interval (CI) 1.01-2.53]. Women using injectable contraception were less likely than those using combined hormonal methods to have average or better physical HRQoL (aOR=0.26, 95% CI 0.09-0.80) and mental HRQoL (aOR=0.24, 95% CI 0.06-0.86). CONCLUSIONS Measures of women's HRQoL differ with contraceptive use.
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Affiliation(s)
- Sanithia L Williams
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Foster DG, Higgins JA, Biggs MA, McCain C, Holtby S, Brindis CD. Willingness to have unprotected sex. JOURNAL OF SEX RESEARCH 2011; 49:61-68. [PMID: 21516592 DOI: 10.1080/00224499.2011.572307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Little is known about people's willingness to engage in sex without protection from unwanted pregnancy. This study surveyed 1,497 women and men at 75 clinics and physician offices across California after their reproductive health care visits in late 2007 and early 2008. When asked if they would have sex without contraception, 30% said definitively that yes, they would have unprotected sex, and 20% indicated they would "sometimes" or "maybe" engage in unprotected sex. In multivariate models, compared to non-Latino White respondents, Latinos who responded to the survey in English were 52% more likely and African Americans were 75% more likely to report willingness to have unprotected intercourse. Wanting a child within the next three years was associated with increased willingness to have unprotected sex. Age, gender, parity, and relationship status were not significant in multivariate models. A considerable proportion of women and men may be willing to have unprotected sex, even with access to subsidized contraceptive services and even when recently counseled about birth control. The dominant behavioral models of contraceptive use need to acknowledge the widespread likelihood of occasional unprotected sex, even among people motivated to usually use contraceptives. Findings underscore the need to make contraceptive methods accessible, easy to use, and even pleasurable.
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Affiliation(s)
- Diana Greene Foster
- Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA 94612, USA.
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Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev 2010; 32:152-74. [PMID: 20570955 PMCID: PMC3115338 DOI: 10.1093/epirev/mxq012] [Citation(s) in RCA: 241] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2010] [Indexed: 01/09/2023] Open
Abstract
Family planning is hailed as one of the great public health achievements of the last century, and worldwide acceptance has risen to three-fifths of exposed couples. In many countries, however, uptake of modern contraception is constrained by limited access and weak service delivery, and the burden of unintended pregnancy is still large. This review focuses on family planning's efficacy in preventing unintended pregnancies and their health burden. The authors first describe an epidemiologic framework for reproductive behavior and pregnancy intendedness and use it to guide the review of 21 recent, individual-level studies of pregnancy intentions, health outcomes, and contraception. They then review population-level studies of family planning's relation to reproductive, maternal, and newborn health benefits. Family planning is documented to prevent mother-child transmission of human immunodeficiency virus, contribute to birth spacing, lower infant mortality risk, and reduce the number of abortions, especially unsafe ones. It is also shown to significantly lower maternal mortality and maternal morbidity associated with unintended pregnancy. Still, a new generation of research is needed to investigate the modest correlation between unintended pregnancy and contraceptive use rates to derive the full health benefits of a proven and cost-effective reproductive technology.
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Affiliation(s)
- Amy O Tsui
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W4041, Baltimore, MD 21205, USA.
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Abstract
OBJECTIVE To estimate the costs of expanding Emergency Medicaid coverage to include postpartum contraception. METHODS A decision-analytic model was developed using three perspectives: the hospital, state Medicaid programs, and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was use to analyze the probability of pregnancy over a 5-year time period. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multiway sensitivity analyses were conducted. A Monte Carlo simulation was performed to incorporate uncertainty from all of the model inputs simultaneously. RESULTS Over a 5-year period, provision of contraception would save society $17,792 per woman in future pregnancy costs and incur a loss of $367 for hospitals. In states in which 49% of immigrants remain in the area for 5 years, such a program would save state Medicaid $108 per woman. CONCLUSION Under federal regulations, new immigrants are restricted to acute, hospital-based care only. Failure to provide the option of contraception postpartum results in increased costs for society and states with long-term immigrants.
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Hock-Long L, Whittaker PG, Herceg-Baron R. Family planning service delivery research: a call to focus on the dynamics of contraceptive use. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:10-11. [PMID: 20415878 DOI: 10.1363/4201010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Health economics of contraception. Best Pract Res Clin Obstet Gynaecol 2009; 23:187-98. [PMID: 19147410 DOI: 10.1016/j.bpobgyn.2008.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/17/2008] [Accepted: 11/18/2008] [Indexed: 11/20/2022]
Abstract
Unintended pregnancies constitute a global problem associated with substantial costs to health and social services, and emotional distress to women, their families and society as a whole. Provision of contraception has been demonstrated to be a particularly cost-effective healthcare intervention as, besides preventing a significant number of unintended pregnancies, it also results in great cost-savings to society. Male and female sterilization and long-acting reversible methods (such as the copper-T intra-uterine device and the subdermal implant) constitute the most cost-effective contraceptive options, followed by other hormonal methods (such as oral contraceptives); barrier and behavioural methods (such as the male condom and withdrawal, respectively) are least cost-effective compared with other contraceptive options. Nevertheless, when compared with no method, they still prevent a large number of unintended pregnancies, thus leading to important cost-savings. Improvements in compliance and continuation rates are expected to further enhance the contraceptive benefits and cost-savings associated with contraceptive use.
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