Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, United States.
Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Contraception. 2021 Feb;103(2):107-112. doi: 10.1016/j.contraception.2020.11.009. Epub 2020 Nov 20.
To evaluate the cost-effectiveness of providing contraceptive implants in school-based health centers (SBHCs) compared to the practice of referring adolescents to non-SBHCs in New York City.
We developed a microsimulation model of teen pregnancy to estimate the cost-effectiveness of immediate provision of contraceptive implants at SBHCs over a 3-year time horizon. Model parameters were derived from both a retrospective chart review of patient data and published literature. The model projected the number of pregnancies as well as the total costs for each intervention scenario. The incremental cost-effectiveness ratio was calculated using the public payer perspective, using direct costs only.
The health care cost of immediate provision of contraceptive implants at SBHCs was projected to be $13,719 per person compared to $13,567 per person for delayed provision at the referral appointment over 3 years. However, immediate provision would prevent 78 more pregnancies per 1000 adolescents over 3 years. The incremental cost-effectiveness ratio for implementing in-school provision was $1940 per additional pregnancy prevented, which was less than the $4206.41 willingness-to-pay threshold. Sensitivity analyses showed that the cost-effectiveness conclusion was robust over a wide range of key model inputs.
Provision of contraceptive implants in SBHCs compared to non-SBHCs is cost-effective for preventing unintended teen pregnancy. Health care providers and policymakers should consider expanding this model of patient-centered health care delivery to other locations.
评估在纽约市的学校保健中心（SBHC）提供避孕植入物与将青少年转介到非 SBHC 的做法相比的成本效益。
我们开发了一个青少年怀孕的微观模拟模型，以估计在 SBHC 中立即提供避孕植入物在 3 年时间内的成本效益。模型参数来自对患者数据的回顾性图表审查和已发表的文献。该模型预测了每种干预方案的怀孕数量和总成本。使用公共支付方视角，仅使用直接成本计算增量成本效益比。
在 3 年内，与在转诊预约时延迟提供相比，在 SBHC 中立即提供避孕植入物的医疗保健成本预计为每人 13719 美元，而每人 13567 美元。然而，立即提供将在 3 年内预防每 1000 名青少年中增加 78 例怀孕。实施校内提供的增量成本效益比为每预防一次额外怀孕 1940 美元，低于 4206.41 美元的支付意愿阈值。敏感性分析表明，在广泛的关键模型输入范围内，成本效益结论是稳健的。
与非 SBHC 相比，在 SBHC 中提供避孕植入物在预防意外青少年怀孕方面具有成本效益。医疗保健提供者和政策制定者应考虑将这种以患者为中心的医疗保健提供模式扩展到其他地点。
