Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

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

93 p.