Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis
Section snippets
Implications
Changing the health care delivery system for adolescent contraception to immediate in-school provision compared to a referral system is cost-effective and should be expanded to other school-based health centers in New York State.
Cost-effectiveness model
We developed a microsimulation model for teen pregnancy to evaluate the cost-effectiveness of providing immediate contraceptive implants to adolescents at SBHCs compared to the practice of referring adolescents to NSBHCs over a 3-year time period [19] from a public payer perspective using direct medical costs only. Different from traditional cost-effectiveness models such as Markov models in which homogeneous populations are simulated, microsimulation models capture heterogeneity in population
Base-case incremental cost-effectiveness analysis
Immediate provision of contraceptive implants at SBHCs would cost $13,719 per person (95% CI $13,129–$14,309) compared to referral to NSBHCs of $13,567 per person (95% CI $12,960–$14,174) in 3 years. This cost includes both contraception cost and pregnancy outcome cost. Provision at SBHCs would cost $152 more upfront because more adolescents receive implants compared to the NSBHC referral, but this immediate provision was projected to prevent 78 more pregnancies per 1000 adolescents over 3
Discussion
SBHCs minimize barriers to access to health care faced by adolescents. Our microsimulation model of teen pregnancy demonstrated that providing contraceptive implants in SBHCs is cost-effective compared to referral to traditional clinics using direct medical costs from a public payer perspective. Our sensitivity analyses further showed the robustness of the cost-effectiveness conclusion favoring provision at SBHCs. Provision of contraceptive implant in SBHCs would cost more upfront because more
Acknowledgments
All persons who contributed to the work reported in the manuscript are listed as authors.
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Declaration of Competing Interest: Chi-Son Kim and Britt Lunde are non-paid trainers for Merck & Co. NexplanonⓇ. Other authors have no disclosures.
Funding: This work was supported by a grant from the Society of Family Planning (grant #SFPRF18-13). The funder did not have any role in study design, collection, analysis, interpretation of data, in the writing of the report, and in the decision to submit the article for publication.