Cost-Benefit Model of Varying Nexplanon and Other Long-Acting Reversible Contraceptive (Larc) Methods: Uptake Compared to the Oral Contraceptive Pill: UK Perspective

Abstract

Objectives: Cost is considered one of the major barriers to greater use of LARC (Long-Acting Reversible Contraceptive) methods, especially cost of treatment initia-tion. However, when considering their contraceptive efficacy alongside cost of preg-nancy, LARC methods are deemed by NICE to be more cost-effective than combined oral contraceptive pills even at one year of use. (NICE LARC CG30 2005). MethOds: A 3 year time-horizon cost-benefit model was developed to assess budgetary impact of increasing LARC uptake (implant, IUD, IUS and injectable) compared to the oral contraceptive pill, in UK women aged 16-49 who currently use the following con-traceptives of interest: non-LARC method (defined as contraceptive pill only) or LARC methods (IUD, IUS, injectable, implant). A weighted-average price based on current market shares was calculated, for all contraceptive pills currently available in the UK. Increased uptake of any LARC method was offset against a reduction in contraceptive pill usage. Unintended pregnancies, based on typical failure rate, occurring with all treatments considered was taken into account. Results: Of approximately 14,750,000 women aged 16-49 in the UK, official statistics confirm 37% use contraceptive methods of interest to our model. This proportion formed our cohort of approximately 5,500,000 UK women aged 16-49, which was followed over a 3 year time horizon. A 100% increase in uptake of each LARC method would lead to a 49% decrease in oral contraceptive pill uptake. Over a three year period this would save 374,794 unintended pregnancies, and elicit financial savings of £630,831,022, on which £54,098,847 is attributable to treatment costs (ingredient, consultations, removal/insertion costs) and £576,732,175 to the cost of unintended pregnancies (live birth, miscarriage, abortion, ectopic pregnancy). cOnclusiOns: The model projects that increasing LARC uptake will result in a significant reduc-tion in the number of unintended pregnancies, with consequent savings to the NHS across the UK. Objectives: Our aim was to assess the costs and consequences of labour induction using misoprostol vaginal insert (MVI) compared with currently used technologies using a specifically developed user-friendly decision model developed for Austria, Poland, Romania, Russia and Slovakia. MethOds: The model was developed in Microsoft Office Excel and compares clinical and safety aspects like time to vaginal delivery, time to active labour, occurrence of cesarean delivery and adverse events of MVI with selected comparators. Efficacy and safety data were retrieved from tar-geted literature review, conducted in the main medical databases. Country-specific information about costs and resource use was incorporated into the model. Local data were collected for each country via a specifically developed questionnaire. The model considered the hospital and public payer perspectives. The model gener-ated results as an incremental difference between the total costs related to labour induction with MVI or a comparator. The threshold price of MVI was also calcu-lated. Results: Local Key Opinion Leaders recommended the following compara-tors: dinoprostone vaginal insert (DVI; Austria), dinoprostone vaginal tablets (Dtab; Austria, Slovakia), dinoprostone cervical gel (Dgel; Poland, Russia, Slovakia) and oxytocin (Austria, Poland, Romania, Russia). The hospital perspective was chosen as default (additionally the public payer perspective was adopted for 2 countries). The use of MVI in most scenarios is related to a reduction in time consumption of hospital staff and in the length of patients' stay in hospital wards. MVI was less costly or marginally more expensive in 80% of cases. cOnclusiOns: Induction of labour with the use of MVI using a hospital perspective, brought savings in most countries and scenarios in comparison to other prostaglandins (DVI, Dtab, Dgel).