Implications of employer coverage of contraception: Cost-effectiveness analysis of contraception coverage under an employer mandate
Implications of employer coverage of contraception: Cost-effectiveness analysis of contraception coverage under an employer mandate
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DOI：
10.1016/j.contraception.2016.08.002
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发表时间：
2017-01-01
期刊：
影响因子：
2.9
通讯作者：
Trussell, J.
中科院分区：
文献类型：
--
作者：
Canestaro, W.;Vodicka, E.;Trussell, J.
目的：在美国，以雇主为基础的强制性避孕保险一直是《平价医疗法案》(ACA)中一个有争议的部分。先前的研究已经检查了避孕的总体成本效益；然而，还没有研究在新的ACA条款的背景下制定正式的决策模型。因此，这项研究的目的是在考虑到允许宗教豁免的新法规的情况下，估计雇主赞助的保险范围下避孕保险的相对成本效益。研究设计：从雇主的角度开发一个决策模型，以模拟与保险范围相关的怀孕成本和结果。避孕失败率、结局和成本的具体方法估计来自文献。结果：不提供避孕保险导致每1000名妇女中意外怀孕增加33例(95%可信区间：22.4；44.0)。这随后大大增加了意外出生和流产的数量。由于妊娠结局费用较高，未参保妇女的总费用较高。没有保险对20-29岁的未婚女性的影响最大。结论：从雇主的角度来看，拒绝女性员工的避孕药具全覆盖增加了总成本，也增加了终止妊娠的总次数。(C)2016 Elsevier Inc.保留所有权利。
Objectives: Mandatory employer-based insurance coverage of contraception in the US has been a controversial component of the Affordable Care Act (ACA). Prior research has examined the cost-effectiveness of contraception in general; however, no studies have developed a formal decision model in the context of the new ACA provisions. As such, this study aims to estimate the relative cost-effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions.Study design: A decision model was developed from the employer perspective to simulate pregnancy costs and outcomes associated with insurance coverage. Method-specific estimates of contraception failure rates, outcomes and costs were derived from the literature. Uptake by marital status and age was drawn from a nationally representative database.Results: Providing no contraception coverage resulted in 33 more unintended pregnancies per 1000 women (95% confidence range: 22.4; 44.0). This subsequently significantly increased the number of unintended births and terminations. Total costs were higher among uninsured women owing to higher costs of pregnancy outcomes. The effect of no insurance was greatest on unmarried women 20-29 years old.Conclusions: Denying female employees' full coverage of contraceptives increases total costs from the employer perspective, as well as the total number of terminations. (C) 2016 Elsevier Inc. All rights reserved.