scholarly journals Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States payer perspective

2021 ◽  
Vol 5 ◽  
pp. 171
Author(s):  
Meenakshi Srinivasan ◽  
Annesha White ◽  
Jason Lott ◽  
Todd Williamson ◽  
Sheldon X Kong ◽  
...  
Keyword(s):  
United States ◽  
Drug Interactions ◽  
Unintended Pregnancy ◽  
Oral Contraceptives ◽  
Pregnancy Outcomes ◽  
The United States ◽  
Reproductive Age ◽  
Contraceptive Failure ◽  
Unintended Pregnancies ◽  
Payer Perspective

Background: In the United States of America (USA), nearly 10 million women use oral contraceptives (OCs). Concomitant administration of certain medications can result in contraceptive failure, and consequently unintended pregnancies due to drug–drug interactions (DDIs). The objective of this analysis was to estimate the economic impact of unintended pregnancies due to DDIs among women of reproductive age using an OC alone or in combination with an enzyme inducer co-medication in the USA from a payer perspective. Methods: A Markov model using a cohort of 1,000 reproductive-age women was developed to estimate costs due to contraceptive failure for OC alone versus OC with concomitant enzyme inducer drugs. All women were assumed to begin an initial state, continuing until experiencing an unintended pregnancy. Unintended pregnancies could result in birth, induced abortion, spontaneous abortion, or ectopic pregnancy. The cohort was analyzed over a time horizon of 1 year with a cycle length of 1 month. Estimates of costs and probabilities of unintended pregnancy outcomes were obtained from the literature. Probabilities from the Markov cohort trace was used to estimate number of pregnancy outcomes. Results: On average, enzyme inducers resulted in 20 additional unintended pregnancies with additional unadjusted and adjusted costs median (range) of USD136,304 (USD57,436–USD320,093) and USD65,146 (USD28,491–USD162,635), respectively. The major component of the direct cost is attributed to the cost of births. Considering the full range of events, DDIs with enzyme inducers could result in 16–25 additional unintended pregnancies and total unadjusted and adjusted costs ranging between USD46,041 to USD399,121 and USD22,839 to USD202,788 respectively. Conclusion: The direct costs associated with unintended pregnancies due to DDIs may be substantial and are potentially avoidable. Greater awareness of DDI risk with oral contraceptives among payers, physicians, pharmacists and patients may reduce unintended pregnancies in at-risk populations.

scholarly journals Reducing the Prevalence of Alcohol-Exposed Pregnancies in the United States: A Simulation Modeling Study

2021 ◽  
pp. 0272989X2110232
Author(s):  
Reza Yaesoubi ◽  
Maya Mahin ◽  
Geoffrey Martin ◽  
A. David Paltiel ◽  
Mona Sharifi
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Reproductive Age ◽  
Drinking Patterns ◽  
Growth Data ◽  
Uncertainty Interval ◽  
Data Set ◽  
Unintended Pregnancies ◽  
Alcohol Abstinence

Background Public health efforts to prevent alcohol-exposed pregnancies (AEPs) primarily focus on promoting abstinence from alcohol among women if pregnant or seeking pregnancy and using effective contraception to prevent unintended pregnancies if consuming alcohol. Little is known about how programs to improve adherence to these recommendations would affect the prevalence of AEPs. Methods We developed an individual-based simulation model of US women of reproductive age to project the prevalence of AEPs under different public health strategies. The model varies each woman’s risk of an AEP over time depending on fertility, contraceptive use, awareness of pregnancy, sexual activity, and drinking patterns. We used the 2013–2015 National Survey on Family Growth data set to parameterize the model. Results We estimate that 54% (95% uncertainty interval: 48%–59%) of pregnancies that result in a live birth in the United States are exposed to alcohol, 12% (10%–15%) are ever exposed to ≥5 alcoholic drinks in a week, and 3.0% (1.3%–4.2%) to ≥9 drinks. Unintended pregnancies (either due to contraceptive failure or sex without contraceptives) account for 80% (75%–87%) of pregnancies unknowingly exposed to alcohol. We project that public health efforts that focus only on promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy could reduce the prevalence of AEPs by at most 42% (36%–48%). Augmenting this strategy with efforts to avert unintended pregnancies could yield an 80% (73%–86%) reduction in the prevalence of AEPs. Conclusions Promoting alcohol abstinence among women who are aware of their pregnancy or seeking pregnancy offers limited potential to reduce the prevalence of AEPs. Programs to avert unintended pregnancies are essential to achieve more substantial reductions in AEPs in the United States.

scholarly journals Descriptors of Cytochrome Inhibitors and Useful Machine Learning Based Methods for the Design of Safer Drugs

2021 ◽  
Vol 14 (5) ◽  
pp. 472
Author(s):  
Tyler C. Beck ◽  
Kyle R. Beck ◽  
Jordan Morningstar ◽  
Menny M. Benjamin ◽  
Russell A. Norris
Keyword(s):  
United States ◽  
Machine Learning ◽  
Drug Interactions ◽  
The United States ◽  
Structural Features ◽  
Physiochemical Properties ◽  
Drug Dosing ◽  
Therapeutic Outcomes ◽  
Cyp Inhibition ◽  
Cyp Inhibitors

Roughly 2.8% of annual hospitalizations are a result of adverse drug interactions in the United States, representing more than 245,000 hospitalizations. Drug–drug interactions commonly arise from major cytochrome P450 (CYP) inhibition. Various approaches are routinely employed in order to reduce the incidence of adverse interactions, such as altering drug dosing schemes and/or minimizing the number of drugs prescribed; however, often, a reduction in the number of medications cannot be achieved without impacting therapeutic outcomes. Nearly 80% of drugs fail in development due to pharmacokinetic issues, outlining the importance of examining cytochrome interactions during preclinical drug design. In this review, we examined the physiochemical and structural properties of small molecule inhibitors of CYPs 3A4, 2D6, 2C19, 2C9, and 1A2. Although CYP inhibitors tend to have distinct physiochemical properties and structural features, these descriptors alone are insufficient to predict major cytochrome inhibition probability and affinity. Machine learning based in silico approaches may be employed as a more robust and accurate way of predicting CYP inhibition. These various approaches are highlighted in the review.

Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences

2021 ◽  
Author(s):  
Carrie Riestenberg ◽  
Anika Jagasia ◽  
Daniela Markovic ◽  
Richard P Buyalos ◽  
Ricardo Azziz
Keyword(s):  
United States ◽  
Polycystic Ovary Syndrome ◽  
Economic Burden ◽  
Polycystic Ovary ◽  
The United States ◽  
Reproductive Age ◽  
Cochrane Library ◽  
Control Group ◽  
Ovary Syndrome

Abstract Context Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5-20% of women of reproductive age. A previous estimate noted that the economic burden of PCOS approximates $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, not considering the costs of pregnancy-related and long-term morbidities. Objective To estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS. Data Sources PubMed, EmBase and Cochrane Library. Study Selection Studies in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health (NIH), or Androgen Excess & PCOS (AE-PCOS) Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling were eligible for inclusion. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index (BMI) were included. Data Extraction Two investigators working independently extracted data on study characteristics and outcomes. Data Synthesis Data was pooled using random-effects meta-analysis. The I 2statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. Results The additional total healthcare-related economic burden due to pregnancy-related and long-term morbidities associated with PCOS in the United States is estimated to be $4.3 billion annually in 2020 USD. Conclusions Together with our prior analysis, the economic burden of PCOS is estimated at $8 billion annually in 2020 USD.

Long-term safety of extended levonorgestrel-containing oral contraceptives in the United States

Contraception ◽  
2021 ◽  
Author(s):  
Sigal Kaplan ◽  
Monica L. Bertoia ◽  
Florence T. Wang ◽  
Li Zhou ◽  
Amir Lass ◽  
...  
Keyword(s):  
United States ◽  
Oral Contraceptives ◽  
The United States
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