Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States 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.

Factors Associated with Abortion Complications after the Implementation of a Surveillance Network (MUSA Network) in a University Hospital

Objective To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish). Methods A cross-sectional study with women who underwent abortion due to any cause and in any age group at UNICAMP Women's Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann–Whitney test, and multiple logistic regression were used for the statistical analysis. Results Overall, 305 women were enrolled (mean ± standard deviation [SD] for age: 29.79 ± 7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71). Conclusion Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.

A rise in births following contraceptive failure in France between 2010 and 2016: results from the French national perinatal surveys

Background In France, while the prevalence of contraception is high, a significant proportion of pregnancies are unintended. Following the 2012 pill scare, the contraceptive method mix, which was mostly comprised of pills and intrauterine devices (IUD), has become more diversified. In this changing landscape, our objective was to describe trends in live births resulting from contraceptive failure and evaluate how patterns of contraceptive use have contributed to observed changes between 2010 and 2016. Methods We used data from the 2010 and the 2016 French National Perinatal surveys which included all births from all maternity units in France over a one-week period. Interviews collecting information about pre-conception contraceptive practices were conducted in the maternity ward post-delivery. Women were classified as having a contraceptive failure if they discontinued contraception because they were pregnant. Our study sample included adult women who had a live birth, had ever used contraception and did not undergo infertility treatment (n = 11,590 in 2010 and n = 9703 in 2016). We evaluated changes in contraceptive failure over time using multivariate Poisson regressions to adjust for sociodemographic characteristics and pre-pregnancy contraceptive methods. Results Pre-pregnancy contraception evolved between 2010 and 2016 with a 12.3% point-drop in pill use, and conversely, 4.6%- and 3.2%-point increases in IUD and condom use, respectively. Use of other barrier or natural methods doubled between 2010 and 2016 but remained marginal (1.4% in 2010 vs 3.6% in 2016). Between 2010 and 2016, the proportion of live births resulting from contraceptive failure rose from 7.8 to 10.0%, with higher risks among younger, parous and socially disadvantaged mothers. The risk ratio of contraceptive failure in 2016 compared to 2010 remained higher after sociodemographic adjustments (aRR = 1.34; 95% CI; 1.23–1.47) and after adjusting for pre-pregnancy contraceptive method mix (aRR = 1.35; 95% CI; 1.25–1.49). Increases in contraceptive failures were concentrated among pill and condom users. Conclusions Recent shifts in contraceptive behaviors in France following the 2012 pill scare may be associated with a subsequent increase in births resulting from short acting contraceptives failures.

Contraceptive method use, discontinuation and failure rates among women aged 15–49 years: evidence from selected low income settings in Kumasi, Ghana

Background This paper provides estimates of contraceptive discontinuation and failure rates in a poor urban setting in Ghana. Contraceptive use is for the purposes of preventing unintended or mistimed pregnancies. Unfortunately, evidence abounds in many parts of the world where there is considerable levels of contraceptive failure and high levels of discontinuation resulting in unintended pregnancies. Methods We estimated discontinuation rates during a 12-month period since starting use by applying single and multiple decrement life table methods to the contraceptive calendar data collected in a survey of women in reproductive age of 15–49 years. Results Modern contraceptive method use was estimated to be 13.7% at the time of the survey. The results show that contraceptive method discontinuation vary markedly by type of contraceptive method but are high for almost all methods, except for implants (23.7%). Discontinuation rate for emergency contraception was estimated at 88.5%, withdrawal 87.6%, and male condom use 80.9%. However, discontinuation rates were moderately high for rhythm (63.6%), pills (65.6%) and injectables (56%). In terms of failure rates, overall contraceptive failure for all methods was estimated at 7.9%. The factors significantly associated with method failure include being within age bracket 40–44 years (OR = 0.3, p < 0.05), having secondary/higher education (OR = 0.4, p < 0.01), belonging to the richest household wealth scale (OR = 3.3, p < 0.01), currently in union with a partner (OR = 2.2, p < 0.01), and using contraceptive methods such as rhythm (OR = 5.6, p < 0.01) and withdrawal (OR = 3.7, p < 0.01). On the flip side, the odds for method discontinuation were significantly higher for women in their 20s and mid 30s, formerly in union (OR = 1.9, p < 0.05) and use of withdrawal method (OR = 1.4, p < 0.05) and lower for women formerly in union (OR = 0.4, p < 0.01) and use of implants (OR = 0.2, p < 0.01) and injectables (OR = 0.6, p < 0.01). Conclusion While contraceptives use is low, both discontinuation and failure rates are high and variable among different methods. Failure and discontinuation rates are lowest for long-acting methods such as implants while higher failure rates are more prevalent among women who rely on withdrawal and the rhythm methods.

Long-Acting Reversible Contraception Versus Pills/Patch/Ring

The CHOICE study was a prospective cohort study of 7486 women in St. Louis, Missouri. The participants underwent standard, scripted contraceptive counseling and were provided with their choice of contraception at no cost. Primary outcomes were contraceptive failure and pregnancy rates in 2 age groups: women over 21 and less than 21 years old. Participants who chose long-acting reversible contraception (LARC) such as an intrauterine device or the contraceptive implant were less likely to experience a contraceptive failure compared to contraceptive pill, patch, ring (PPR) users (p = 0.001). Participants using PPR were 22 times more likely to have an unintended pregnancy than those using LARC. Among women less than 21 years old who used non-LARC methods, the risk of pregnancy was nearly twice as high than older women. LARC are highly-effective and safe for women of all ages and should be considered first-line methods of contraception for most patients.

Analysis the contraception usage and unmet needs of education and reproductive health in Hubei province, China

background: In recent years, contraceptives have developed rapidly, which are divided into modern contraceptives and non-modern contraceptives. The use of contraceptives less unwanted pregnancy and sexually transmitted infections(STIs) including HIV. And cause traditional attitudes towards sex, marriage and family have changed. It leads to a lack of caution about sex and pre-marital sex is more acceptable. Hence, the number of miscarriages caused by unwanted pregnancies has increased. People is going to settle many of sexual and reproductive health matters. Methods: This study, was conducted of about 103 counties in Hubei Province from August 2014 to July 2016, which used frequencies, percentage, mean, chi-square, logistic regression to analysis this data that collected from 17555 respondents. (IBM-SPSS v 25.0)Results: The results in this article describe more men (62.6%) received family planning services education than women (37.4%). And people who did not participate in family planning services education, 17.0% and 21.9% did not know about vasectomy and withdrew as a method of male contraception, respectively. Striking, up to 23.9% and 22.8% of people with or without participating in family planning services education had experienced contraceptive failure (pregnancy for example) in couple. Age, educational, occupational status and the number of living children were strongly associated with contraceptive failure within participating in family planning services education. Only age, place of residence and number of living children were significant associated with contraceptive failure without participating in family planning services education. The figure showed greatly unmet needs of education and reproductive health whether or not to accept family planning services educationConclusion: There is a huge difference in Knowledge and use of contraceptives, as well as unmet educational and reproductive health needs between those who participated in family planning services education and those who did not. That means people who participate in family planning services education got more about sexual and reproductive health education and understand the important of the family planning services. Therefore, it is necessary to provide family planning services for more people and regions to obtain a good understanding of contraceptives, sexual intercourse and unintended pregnancy.

Factors Related To Abortus Events In Mitra Medika Rsu Tanjung Mulia Medan In 2019

<p><em>Abortion is an important problem in public health because it affects maternal morbidity and mortality. Based on data from the World Health Organization (WHO) in 2016, around 830 women die from pregnancy-related complications worldwide every day. During 2010-2014, an estimated 56 million abortions occur each year worldwide. The aim is to find out factors related to the abortion at Mitra Medika Tanjung Mulia Medan Hospital in 2019.</em></p><pre><strong><em> </em></strong><em>This research uses a Mix Methods research with a Sequential Explanatory strategy. The approach used in quantitative retrospectives and qualitative uses a case study approach. The population </em><em>in</em><em> this study were all pregnant women who experienced abortion recorded in the medical records of Mitra Medika Hospital Tanjung Mulia Medan as many as 73 respondents. The sample in a quantitative approach of 73 respondents with the technique of Total Population while for qualitative 2 pregnant women who have abortion, 2 husbands, 1 midwife. Data collection is carried out with primary, secondary and tertiary data. Data analysis was performed by univariate, bivariate analysis. Qualitative </em><em>data</em><em> analysis with data reduction, data presentation, and drawing conclusions.</em></pre><pre><em> </em><em>Data obtained from the results of statistical tests show there is a relationship between age and abortion p value 0.005, there is a relationship of work with abortion p value 0.017, there is a relationship of parity with abortion p value 0.022, there is a relationship between historical abortion with abortion p value 0.001. And there is no correlation between contraceptive failure and abortion p value 0.297. Qualitatively based on in-depth interviews with informants that the cause of the occurrence of abortion is due to the age of the mother at risk, a history of previous abortion and fatigue at work. Another factor related to the incidence of abortion is husband's support.</em></pre><p><em> The conclusion of this study is that there is a relationship between age, occupation, parity, history of abortion of pregnant women with abortion and there is no relationship between contraceptive failure of pregnant women with abortion in Mitra Medika Tanjung Mulia Hospital in 2019. It is expected that health workers can improve the quality of services in efforts to manage abortion and providing information about pre-conception preparation and health monitoring during pregnancy.</em><em></em></p>

Vasectomy: can the standards be achieved within a primary care setting?

BackgroundVasectomy intends to provide permanent contraception by interrupting the vas deferentia via one of several methods. The no-scalpel vasectomy aims to render male sterilisation more acceptable to patients. It is faster and associated with fewer complications. Complications are uncommon, but do exist, most often pain, bleeding, bruising, and infection. Vasectomy is increasingly carried out within a primary care setting. One GP at Marple Cottage Surgery has been performing vasectomies for 5 years.AimThis study aims to ascertain whether vasectomy standards can be achieved within a primary care setting.MethodElectronic patient records and semen analysis data were accessed for procedures performed between April 2013–April 2018, to calculate the failure and complication rates. This was compared to guidelines from relevant advisory bodies.ResultsIn total 910 vasectomies were performed over the period: 5.3% were associated with a complication; 2.0% intraoperative bleeding, 1.5% pain, 0.8% haematoma, 0.7% syncope, and 0.2% infection. Two-thirds (67.3%) of patients provided a semen sample for analysis. The occlusive failure rate was 0.4% and the contraceptive failure rate is 0%.ConclusionComplication rates were low, achieving or exceeding the standards in all domains. The occlusive failure rate is within the <1% American Urological Association acceptable standard and the current contraceptive failure rate is 0%. This is for further analysis with a larger sample size. We are confident that the high standard of vasectomy care can be achieved as the service migrates into primary care.