Study Of Economic Assessment On Contraceptive Technology

Objective:To evaluate the short-term and long-term economic effect of four sorts of longacting contraceptive technologies so as to provide evidence base for government to make decisions as well as reference information for contraceptive users to make well-informed clinical decisions.It is also to provide methodology foundation for similar studies and for international comparison.Study Contents:1.Contraceptive cost calculation from provider perspective and societal perspective,respectively.2.Short-term and long-term efficacy measurement of four sorts of contraceptive technologies.3.To measure and compare the impact of contraceptive technologies on the quality of life of contraceptive users.4.To construct a decision-tree model for short-term economic assessment and to conduct cost-effectiveness analysis of contraceptive technologies.5.To construct a Markov model for long-term simulation and to perform cost-effectiveness analysis of contraceptive technologies.Methods:1 Cost calculation69 county-level family planning service facilities in 7 provinces were investigated,basic information of each county and cost data of each facility were collected from Jan.1_st,2007 to Dec.31^st,2007.Direct medical cost of four sorts of contraceptive technologies was calculated using Methodology of Institutional Cost Analysis and Item Cost Calculation.And direct non-medical cost and indirect cost were estimated from the database of the Mega-projects of Science Research for the 11^th Five-Year Plan-Comprehensive Evaluation on Contraceptive Technologies.2 Efficacy measurementMulti-center clinical data about efficiency and safety of four sorts of contraceptive technologies was extracted from the prospective cohort database of the 11^th Five-Year Project,and short-term clinical efficacy indicators were measured. Other indicators which could not be extracted from the database were supplemented by literature systematic review.3 Quality of life measurementThe Impact of different contraceptives on users' quality of life was measured in different periods of time using Chinese version SF-36 questionnaire.Users' demographic and clinical characteristics were surveyed as well.4 Short-term economic assessmentA decision-tree model for short-term economic evaluation of contraceptive technologies was conducted on the basis of experts' opinions and literature review. Short-term cost-effectiveness comparison of contraceptives was conducted using decision analysis and sensitivity analysis.5 Long-term economic assessmentA Markov probability transition model for long-term economic evaluation of contraceptive technologies was conducted on the basis of experts' opinions and literature review.Transition probabilities in the model were determined by effectiveness measurement.Long-term cost-effectiveness comparison of contraceptives was performed in a 5-year cycle through model simulation and sensitivity analysis. Results:1 Controlled for economic development level,direct medical cost of contraceptive technologies was calculated from the service provider perspective.The result showed that tubal ligation costedï¿¥511.59 per person,sub-dermal implant costedï¿¥172.33 per person,vasectomy costedï¿¥129.58 per person and injectables costedï¿¥78.99 per person.While from the societal perspective,tubal ligation costedï¿¥1306.71 per person,vasectomy costedï¿¥571.04 per person,sub-dermal implant costedï¿¥292.81 per person,and injectables costedï¿¥96.63 per person.2 The success rate of each contraceptive was higher than 98%.Ectopic pregnancy occurred more often among tubal ligation users than in ordinary population. Tubal ligation and vasectomy induced more kinds of complications with the one-year cumulative incidence rate around 1%.Injectable users suffered side effects like menstrual disorder with a relatively high cumulative incidence of 44.16%per year, and had a high discontinued rate.3 The Chinese version SF-36 questionnaire demonstrated moderately good consistency and validity in evaluating the quality of life of population with reproductive age.Tubal ligation improved users' short-term physical health more than other contraceptives,injectables improved users' mental health more than other contraceptives.However,injectables and vasectomy played most negative impact on users' short-term physical health,and tubal ligation played most negative impact on users' short-term mental health.4 From perspective of service provider,using success rate,Physical Component Summary(PCS) and Mental Component Summary(MCS) as effectiveness indicators, injectables dominated all the contraceptives during one year of use.From societal perspective,using different effectiveness indicators,sub-dermal implant dominated all the contraceptives during one year of use.One-way sensitivity analysis indicated little influence on evaluation results.5 From perspective of provider,using success rate,continue rate as effectiveness indicators,vasectomy dominated all the contraceptives after five year of use.From societal perspective,using different effectiveness indicators,sub-dermal implant dominated all the contraceptives after five year of use.Sensitivity analysis showed little influence on evaluation results.In conclusion,the assessment results differed by different scenario,perspective,study time horizon and indicators,appropriate perspective,time horizon and indicators should be determined by practical environment.Conclusions:1 Tubal ligation costed highest at baseline,and had a cost decline in the long run; injectables costed lowest at baseline,and induced cost increase in a long-term period.2 The assessed four sorts of contraceptives had moderately fine clinical efficacy.The cumulative incidence rate of complications after tubal ligation and vasectomy were about 1%,injectables users incurred more side effects than other contraceptives.3 The Chinese version SF-36 questionnaire was adapted to measure the quality of life of population with reproductive age.Tubal ligation had most positive impact on users' physical health,whilc injectables had most positive impact on users' mental health.4 During a short-term period of one-year,using different effectiveness indicators, from provider perspective,injectables dominated all the contraceptives;from societal perspective,sub-dermal implant dominated all the contraceptive technologies.5 After five-year of use,using different effectiveness indicators,from provider perspective,injectables dominated all the contraceptives;from societal perspective, sub-dermal implant dominated all the contraceptive technologies.Suggestions:1 Financial compensation standards should be determined based on the cost of contraceptive service provision.2 Economic evaluations on contraceptive technologies should be widely applied to provide evidence base for decision-making.