Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
Popul Health Manag. 2022 Aug;25(4):542-550. doi: 10.1089/pop.2021.0392. Epub 2022 May 6.
This study assesses cost savings associated with specific contraceptive methods provided to beneficiaries enrolled in South Carolina Medicaid between 2012 and 2018. Incremental cost-effectiveness ratios, defined as the additional cost of contraception provision per live birth averted, were estimated for 4 contraceptive methods (intrauterine devices [IUDs], implants, injectable contraceptives, and pills), relative to no prescription method provision, and savings per dollar spent on method provision were calculated. Costs associated with publicly funded live births were derived from published sources. The analysis was conducted for the entire Medicaid sample and separately for individuals enrolled under low-income families (LIFs), family planning, and partners for healthy children (PHC) eligibility programs. Sensitivity analysis was performed on contraceptive method costs. IUDs and implants were the most cost-effective with cost savings of up to $14.4 and $7.2 for every dollar spent in method provision, respectively. Injectable contraceptives and pills each yielded up to $4.8 per dollar spent. However, IUDs and implants were less cost-effective than injectable contraceptives and pills if the average length of use was less than 2 years. Medicaid's savings varied across Medicaid eligibility programs, with the highest and lowest savings from contraceptive provision to women in the LIFs and PHC eligibility programs, respectively. The results suggest the need to account for unique needs and preferences of beneficiaries in different Medicaid eligibility categories during contraception provision. The findings also inform program administration and provide evidence to justify legislative appropriations for Medicaid reproductive health care services.
本研究评估了 2012 年至 2018 年期间南卡罗来纳州医疗补助计划（Medicaid）参保者使用特定避孕方法的成本节约情况。针对 4 种避孕方法（宫内节育器[IUD]、植入物、注射避孕药和避孕药），相对于不提供处方避孕方法的情况，估计了增量成本效益比（定义为每避免一次活产所需增加的避孕提供成本），并计算了每美元用于方法提供的节省。与公共资金支持的活产相关的成本来自已发表的来源。该分析针对整个医疗补助样本进行，并分别针对低收入家庭（LIF）、计划生育和健康儿童伙伴（PHC）资格计划下的参保者进行。对避孕方法成本进行了敏感性分析。IUD 和植入物是最具成本效益的方法，每提供 1 美元的方法成本，可节省多达 14.4 美元和 7.2 美元。注射避孕药和避孕药每提供 1 美元，可节省多达 4.8 美元。然而，如果使用期限少于 2 年，IUD 和植入物的成本效益就不如注射避孕药和避孕药。医疗补助的节省因医疗补助资格计划而异，在 LIF 和 PHC 资格计划中，为女性提供避孕措施的节省最高和最低。研究结果表明，在提供避孕措施时，需要考虑不同医疗补助资格类别中受益人的独特需求和偏好。研究结果还为项目管理提供了信息，并为医疗补助生殖健康服务的立法拨款提供了证据。
