1
|
Lopes da Silva Filho A, Luis Pereira Bueno R, Ramires Y, Lino LMC. Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system. PLoS One 2024; 19:e0301207. [PMID: 38547099 PMCID: PMC10977723 DOI: 10.1371/journal.pone.0301207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.
Collapse
Affiliation(s)
- Agnaldo Lopes da Silva Filho
- Medicine Faculty, Gynecology Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Luis Pereira Bueno
- Business Graduate Program of University 9 of July (PPGA-UNINOVE), São Paulo, Brazil
- Organon & Co., São Paulo, Brazil
| | - Yohanna Ramires
- Organon & Co., São Paulo, Brazil
- Postgraduate Program in Pharmaceutical Science, Federal University of Paraná, Curiba, Paraná, Brazil
| | - Lara Marina Cruz Lino
- Organon & Co., São Paulo, Brazil
- Master’s Business Administration in Health Program, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
2
|
Zell B, Effland K, Snyder M, Hays K, Gordon W. Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception. J Midwifery Womens Health 2024. [PMID: 38229277 DOI: 10.1111/jmwh.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/18/2023] [Indexed: 01/18/2024]
Abstract
Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives' Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
Collapse
Affiliation(s)
| | - Kristin Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | | | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | - Wendy Gordon
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| |
Collapse
|
3
|
de Molina-Fernandez MI, Reyes-Martí L, De la Flor-López M, Aguarón-García MJ, Roca-Biosca A, Rubio-Rico L, Raventós Torner RD, Valls-Fonayet F. Medication Adherence and Contraceptive Counseling. Healthcare (Basel) 2023; 11:healthcare11091304. [PMID: 37174846 PMCID: PMC10178153 DOI: 10.3390/healthcare11091304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Combined oral contraceptives (COC) are a very popular form of birth control. Incorrect use and lack of adherence to treatment reduce the effectiveness of this method. Having a standard tool to identify poor-adherence profiles quickly and objectively can be helpful for midwives and potentially for COC users. The MMAS-4 adherence scale has been used in various medical fields, but there is little evidence of its potential in contraceptive consultation. This paper presents a piece of multicenter observational research based on a sample of 327 women who had attended contraceptive counselling in Spain and were COC users or had informed the midwife that they want to start to use this method. Two interviews were conducted: at the time of consultation and after one year. In our research, the MMAS-4 identified high-risk behaviors: during the 1-year follow-up period, COC users classified as poorly adherent had a significantly higher risk of missed contraceptive pills, more incidents and problems related to the method of contraception, as well as a lower degree of satisfaction with the contraceptive method. One case of unplanned pregnancy and two cases of emergency contraception were identified, all of them corresponding to poorly adherent women. The use of MMAS-4 in consultation can improve midwives' contraceptive counselling.
Collapse
Affiliation(s)
| | - Laura Reyes-Martí
- Nursing Department, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | | | | | - Alba Roca-Biosca
- Nursing Department, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | - Lourdes Rubio-Rico
- Nursing Department, Universitat Rovira i Virgili, 43002 Tarragona, Spain
| | | | | |
Collapse
|
4
|
Barbieri MM, Dantas-Silva A, Caleffi LS, Morais SS, Juliato CRT, Bahamondes L, Surita FG. One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents. EUR J CONTRACEP REPR 2023; 28:58-64. [PMID: 36287505 DOI: 10.1080/13625187.2022.2133536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. MATERIALS AND METHODS We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. RESULTS We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99-1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort. CONCLUSION Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.
Collapse
Affiliation(s)
- Mariane M Barbieri
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Amanda Dantas-Silva
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Leticia S Caleffi
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Sirlei S Morais
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Cassia R T Juliato
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| |
Collapse
|
5
|
Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women's contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:267-274. [PMID: 35228303 DOI: 10.1136/bmjsrh-2021-201301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Contraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women's contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake. METHOD We used Facebook advertising to recruit young women aged 16-25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations). RESULTS A total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11). CONCLUSIONS Many young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.
Collapse
Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Pip Buckingham
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edwina McCarthy
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Nelson HD, Cantor A, Jungbauer RM, Eden KB, Darney B, Ahrens K, Burgess A, Atchison C, Goueth R, Fu R. Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:980-993. [PMID: 35605239 PMCID: PMC10185303 DOI: 10.7326/m21-4380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effectiveness and harms of contraceptive counseling and provision interventions are unclear. PURPOSE To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives and reduce unintended pregnancy, as well as evidence of their potential harms. DATA SOURCES English-language searches of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1 January 2000 to 3 February 2022) and reference lists of key studies and systematic reviews. STUDY SELECTION Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both versus usual care or an active control. DATA EXTRACTION Dual extraction and quality assessment of studies; results combined using a profile likelihood random-effects model. DATA SYNTHESIS A total of 38 trials (43 articles [25 472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions (risk ratio [RR], 1.39 [95% CI, 1.16 to 1.72]; I 2 = 85.3%; 10 trials), provision of emergency contraception in advance of use (RR, 2.12 [CI, 1.79 to 2.36]; I 2 = 0.0%; 8 trials), and counseling or provision postpartum (RR, 1.15 [CI, 1.01 to 1.52]; I 2 = 6.6%; 5 trials) or at the time of abortion (RR, 1.19 [CI, 1.09 to 1.32]; I 2 = 0.0%; 5 trials) than with usual care or active controls in multiple clinical settings. Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Interventions did not increase risk for sexually transmitted infections (STIs) (RR, 1.05 [CI, 0.87 to 1.25]; I 2 = 0.0%; 5 trials) or reduce condom use (RR, 1.03 [CI, 0.94 to 1.13]; I 2 = 0.0%; 6 trials). LIMITATION Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes. CONCLUSION Contraceptive counseling and provision interventions that provide services beyond usual care increase contraceptive use without increasing STIs or reducing condom use. Contraceptive care in clinical practice could be improved by implementing enhanced contraceptive counseling, provision, and follow-up; providing emergency contraception in advance; and delivering contraceptive services immediately postpartum or at the time of abortion. PRIMARY FUNDING SOURCE Resources Legacy Fund. (PROSPERO: CRD42020192981).
Collapse
Affiliation(s)
- Heidi D Nelson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Amy Cantor
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rebecca M Jungbauer
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Karen B Eden
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Blair Darney
- Oregon Health & Science University and Portland State University School of Public Health, Portland, Oregon, and Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Cuernavaca, México (B.D.)
| | - Katherine Ahrens
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Amanda Burgess
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Chandler Atchison
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rose Goueth
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rongwei Fu
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| |
Collapse
|
7
|
Farah D, de Moraes Andrade TR, Sansone D, Batista Castello Girão MJ, Fonseca MCM. A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System. Am J Prev Med 2022; 62:114-121. [PMID: 34922650 DOI: 10.1016/j.amepre.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of long-acting reversible contraceptives is low among adolescents owing to the high up-front cost. In this study, a 5-year cost-effectiveness model and budget impact analysis were used to compare the use of long-acting reversible contraceptives with the use of combined oral contraceptives among Brazilian adolescents. METHODS A Markov model was developed to mirror the clinical and economic effects of long-acting reversible contraceptives among sexually active Brazilian adolescents in the public health system for a 5-year duration, starting from 2018. The costs were expressed in U.S.$, and a 5% discount rate was applied for both costs and benefits. Model inputs included costs of the contraceptive methods, contraceptive discontinuation and adherence rates, abortion, and birth costs associated with unintended pregnancies. The model outcomes were avoided pregnancies, abortions, and births. Univariate and probabilistic sensitivity analyses were conducted. RESULTS Copper intrauterine device use was dominant 100% of the time for all outcomes, and a budget impact analysis revealed a cost savings of $422,431,269.10 in the 5-year period. Levonorgestrel intrauterine system and subdermal implant use were cost effective for all outcomes. The budget impact analyses revealed costs of $65,645,417.54 for levonorgestrel intrauterine system and $302,852,972.12 for subdermal implant use during the 5-year study period. CONCLUSIONS According to this Brazilian model, copper intrauterine device use is dominant, and levonorgestrel intrauterine systems and subdermal implants are more cost effective than combined oral contraceptives.
Collapse
Affiliation(s)
- Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Dayan Sansone
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manoel João Batista Castello Girão
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
| |
Collapse
|