Economic analysis of contraceptives for women
Economic analysis of contraceptives for women
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DOI：
10.1016/s0010-7824(03)00078-7
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发表时间：
2003-07-01
期刊：
影响因子：
2.9
通讯作者：
Borenstein, J
中科院分区：
文献类型：
--
作者：
Chiou, CF;Trussell, J;Borenstein, J
目的：从医疗保健服务支付者的角度来研究避孕药具提供给妇女在UnitedStates.Methods的经济后果：一个马尔可夫模型被构建来比较9种避孕方法（包括3个月注射）的有效性和成本。口服避孕药、宫内节育器（IUD）、宫内系统（IUS）、屏障方法和手术方法）。主要健康状态包括首次/持续使用、方法失败和方法停止，每年过渡5年。该模型中还纳入了计划注销。事件概率、所用资源和基础病例成本的估计来自综合文献综述、平均批发药品价格、2000年医疗保险报销费用表和MEDSTAT 2000年DRG指南，并结合专家意见。结果：除输精管结扎术外，最有效的方法是输卵管结扎术，左炔诺孕酮（LNG）-20 IUS和铜T380 A IUD。最便宜的方法（占所有费用）是LNG-20 IUS，铜T 380 A IUD和3个月注射：5年的成本/人分别为1646美元，1678美元和2195美元，从第三方支付的角度来看，LNG-20 IUS和铜T 380 A IUD占主导地位的所有审查的方法，除了输卵管结扎。然而，输卵管结扎术的避孕效果的小幅增加具有很高的成本。IUD和IUS装置成本对这两种方法的相对成本效益有显著影响。(C)2003年爱思唯尔公司All rights reserved.
Objective: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States.Methods: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable. oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables.Results: Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable: the 5-year cost/person were $1646, $1678 and $2195, respectively.Conclusion From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods. (C) 2003 Elsevier Inc. All rights reserved.