Elsevier

Contraception

Volume 103, Issue 2, February 2021, Pages 107-112
Contraception

Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis

https://doi.org/10.1016/j.contraception.2020.11.009Get rights and content

Abstract

Objective

To evaluate the cost-effectiveness of providing contraceptive implants in school-based health centers (SBHCs) compared to the practice of referring adolescents to non-SBHCs in New York City.

Study Design

We developed a microsimulation model of teen pregnancy to estimate the cost-effectiveness of immediate provision of contraceptive implants at SBHCs over a 3-year time horizon. Model parameters were derived from both a retrospective chart review of patient data and published literature. The model projected the number of pregnancies as well as the total costs for each intervention scenario. The incremental cost-effectiveness ratio was calculated using the public payer perspective, using direct costs only.

Results

The health care cost of immediate provision of contraceptive implants at SBHCs was projected to be $13,719 per person compared to $13,567 per person for delayed provision at the referral appointment over 3 years. However, immediate provision would prevent 78 more pregnancies per 1000 adolescents over 3 years. The incremental cost-effectiveness ratio for implementing in-school provision was $1940 per additional pregnancy prevented, which was less than the $4206.41 willingness-to-pay threshold. Sensitivity analyses showed that the cost-effectiveness conclusion was robust over a wide range of key model inputs.

Conclusion

Provision of contraceptive implants in SBHCs compared to non-SBHCs is cost-effective for preventing unintended teen pregnancy. Health care providers and policymakers should consider expanding this model of patient-centered health care delivery to other locations.

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.

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