Date of Award
Doctor of Philosophy (PhD)
Sarah H. Heil
Background: In the BCII randomized clinical trial, women receiving medication for opioid use disorder (OUD) and at risk of unintended pregnancy who received contraceptive services interventions co-located with an OUD treatment facility had significantly higher rates of prescription contraceptive use than those who received usual care. To support informed decision-making about using these interventions in community-based settings, I conducted a cost-effectiveness analysis to determine the costs and health benefits associated with these interventions.
Methods: I used the standard practice of calculating incremental cost effectiveness ratios (ICERs) between the trial conditions (i.e., usual care, contraceptive services, and contraceptive services + incentives) and derived the estimated societal cost of an unintended pregnancy for women with OUD to assess cost-effectiveness, from a societal perspective.
Results: ICERs (95% confidence intervals) were $15,223 ($8,155-$28,323) for contraceptive services vs. usual care, $13,852 ($10,298-$20,065) for contraceptive services + incentives vs. usual care, and $12,225 ($5,273-$63,725) for contraceptive services + incentives vs. contraceptive services, per unintended pregnancy averted. Based on an estimated unintended pregnancy cost of $85,122, each dollar invested in contraceptive services vs. usual care yields $5.59 in societal cost savings and $6.14 for contraceptive services + incentives vs. usual care. Every dollar spent using incentives with contraceptive services yields $6.96 in societal cost savings vs. contraceptive services with no incentives.
Discussion: The present study is the first rigorous economic evaluation of novel contraceptive services interventions for women with substance use disorders. Both interventions are highly cost-effective strategies to reduce the risk of unintended pregnancy for women in this population compared to usual care and yield substantial societal cost savings, but the most efficacious and cost-effective outcomes were achieved by combining contraceptive services with incentives.
Number of Pages
Melbostad, Heidi S., "Cost-Effectiveness Analysis Of Two Contraceptive Services Interventions For Women Receiving Medication For Opioid Use Disorder And At Risk Of Unintended Pregnancy" (2020). Graduate College Dissertations and Theses. 1284.
Available for download on Thursday, August 11, 2022