Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, WN5002-665 William Ave, Winnipeg, MB, R3E 0L8, Canada.
BMC Health Serv Res. 2022 Sep 1;22(1):1110. doi: 10.1186/s12913-022-08416-1.
In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes.
We undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies.
Quebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus.
We identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.
在加拿大，由于成本问题，紧急避孕（EC）药物的可及性受到限制，而这种药物可能有助于预防意外怀孕。醋酸乌利司他（UPA-EC）比之前的标准左炔诺孕酮（LNG-EC）在临床效果和成本效益方面更具优势。我们分析了省级 EC 补贴政策，并研究了潜在的决策过程。
我们对公开的药物处方中省级 EC 补贴政策进行了文献分析。我们对主要利益相关者进行了半结构化访谈，以探讨当前政策背后的过程。
魁北克省是唯一补贴 UPA-EC 的省份，而所有十个省份都补贴 LNG-EC。因此，省级 EC 补贴政策与最新的 UPA-EC 证据不符。访谈显示，证据在决策过程中受到重视，通过跨学科共识做出了药物处方决定。
我们发现 EC 补贴政策与最新证据之间存在差距。制度结构影响反映不断发展的证据的政策。增加跨学科机制可能会鼓励基于证据的政策。
