摘要：Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. Unintended pregnancies occur increasingly and disproportionately to women with limited resources. 1 Cost–benefit analyses have repeatedly shown substantial savings to the public in pregnancy-related medical expenses from the provision of contraceptive services to low-income women. 2 – 4 However, these analyses have not been conducted for specific types of contraceptive methods, with the exception of a 1995 study by Trussell et al. comparing the costs of using 15 different methods of contraception, including the costs of providing the method and the costs of unintended pregnancies. 5 Trussell et al. showed the theoretical cost-effectiveness of 5 years' use of contraceptive methods, not taking into account the costs of providing other method-related services or the likelihood of method discontinuation. Although Trussell et al. show that all methods can be cost-effective, it is not known what the relative cost-effectiveness of specific methods is when cost data are derived from an actual public health program and the tendency of a significant proportion of women to switch and discontinue methods is taken into account. California's family planning program, Family PACT (Planning, Access, Care and Treatment), provides contraception and reproductive health services to women and men of reproductive age whose incomes do not exceed 200% of the federal poverty level and who have no other reproductive health care coverage. More than 2000 private and nonprofit providers across the state deliver family planning services and are reimbursed by the Family PACT program on a fee-for-service basis. 6 The program was launched in 1997 and grew rapidly, serving 750 000 clients during its first full year of operation and more than 1.6 million per year in recent years. 7 The size of the program and the detailed data kept by the program on contraceptive methods dispensed permit an analysis of the cost-effectiveness of specific methods of contraception. Family PACT covers all contraceptive methods approved by the Food and Drug Administration at no cost to the client. Methods available since the program's inception include oral contraceptives, injectable contraceptives, intrauterine contraceptives, sterilization, and barrier methods. Dedicated emergency contraceptive pills became available in 1999, and the new contraceptive patch and vaginal ring were added to the formulary in 2002. With the introduction of new contraceptive methods, the pattern of methods dispensed through Family PACT has changed: by 2005, nearly 20% of women served each year received at least 1 pack of emergency contraceptives, 15% received a contraceptive patch, and 2% received a contraceptive ring, whereas the percentage of women receiving oral and injectable contraceptives has slightly declined. The percentage of women receiving barrier methods with or without another contraceptive has remained steady at around 45%. 7 Given their limited time on the market and a lack of large-scale data on contraceptive method dispensing, little is known about the women using the new methods and the effect of these methods on unintended pregnancy. There has been some criticism of the high cost of the contraceptive patch and ring. 8 However, given the absence of data on use of these methods and the cost of providing them, there has been no way to assess the validity of these criticisms. We assessed the cost-effectiveness of covering new contraceptive methods for women aged 13 to 44 years and evaluated the relative contribution of all methods to the fertility effect of the Family PACT Program. We compared the costs of providing contraceptives through Family PACT with the costs of unintended pregnancies to government programs.
