OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.
To assess the effectiveness of a vitamin/mineral supplement in controlling symptoms of premenstrual syndrome (PMS), we conducted a double-blind randomized study on 44 women with PMS. Subjects were carefully screened and excluded if underlying physical or psychopathological conditions were noted. Follicular and luteal testing with a menstrual symptom questionnaire, subdividing PMS into four subgroups, was completed for 1 month prior to treatment and for three menstrual cycles during treatment. Subjects were randomly assigned to receive either placebo or six or 12 tablets of the supplement a day for three menstrual cycles. All subjects had significant differences in severity of symptoms between the follicular and luteal phase of the control cycle. Comparing pre- vs posttreatment luteal phase scores, significant placebo effects were noted for two PMS subgroups. Significant treatment effects were noted in three subgroups for the six-tablet group and in all four subgroups for the 12-tablet group. These results suggest that this nutritional supplement may play a role in the management of women with PMS.
Norgestimate (NGM), a derivative of 19-nortestosterone with very specific affinity for the progesterone receptor, has been used in combination with ethinyl estradiol (EE) at low doses in both monophasic and triphasic oral contraceptives (OCs). An open-label comparative clinical trial was conducted with 4,234 healthy women using triphasic levonorgestrel (LNG)/EE and NGM/EE through a total of 22.312 menstrual cycles. Contraceptive efficacy was excellent with both preparations, with no statistically significant between-regimen differences in pregnancy rates. The theoretical Pearl index was 0.12 for the NGMlEE triphasic, and 0.34 for the LNGlEE triphasic. Adverse experiences in both groups were typical of those that may occur among women taking low-dose OC agents. The percentage of subjects discontinuing treatment because of use-related adverse experiences was similar with the two preparations: 8.6% for the NGM/EE triphasic and 6.8%for the LNGiEE triphasic. In a separate mechanism of action study, specific endocrine parameters were investigated in 20 subjects using the NGM/EE triphasic for 4 cycles. Ovulation suppression was demonstrated in statistically significant decreases from pretreatment values in serum levels of luteinizing hormone, follicle-stimulating hormone, progesterone, and estradiol. Significant on-treatment increases in serum levels of sex hormone binding globulin evidenced minimal androgenicity. All hormonal values returned to or toward normal in the post-treatment cycle. The study results support those obtained in large noncornparative studies of the NGM/EE triphasic. This phased-dose combination suppresses ovulation and is a very effective, minimally androgenic contraceptive agent with a good safety profile.
Twenty-six patients with clinically confirmed mammary dysplasia and five age-matched controls were treated with alpha-tocopherol, 600 mg/day. Serum samples collected on the 21st day of the menstrual cycle were analyzed for cholesterol in lipoprotein fractions, isolated by a combination of precipitation and ultracentrifugation techniques. Eighty-five percent of patients showed objective and subjective remission from disease following therapy. In mammary dysplasia patients, the ratio of serum cholesterol/high density lipoprotein cholesterol was higher than those in age-matched controls, an abnormality which was corrected by alpha-tocopherol therapy. Furthermore, as a result of therapy, high density lipoproteins increased and ester cholesterol associated with low density lipoproteins decreased. The results suggest that alpha-tocopherol may serve as an effective agent in treating patients with benign disease, as well as correct the inherent abnormality in serum cholesterol distribution in mammary dysplasia patients.
Vaginitis is one of the most common reasons women access health care in the United States. Despite its prevalence and disruptive impact, it is frequently misdiagnosed and untreated, resulting in unnecessary patient discomfort, follow-up visits, and health care costs. This study presents a costs analysis of diagnostic testing technologies to demonstrate the potential of molecular tests to improve the value of care for women with vaginitis. This study tracks health care spending among women diagnosed with vaginitis and finds that nucleic acid amplification tests (NAATs) are cost-effective for the diagnosis of vaginal symptoms. Women who receive a NAAT on the day of their diagnosis have significantly lower 12-month follow-up costs compared to women who receive a direct probe test or those women who are clinically evaluated without the use of a molecular test. However, despite Food and Drug Administration approval, widely available molecular diagnostics have not been incorporated into clinical guidelines, and many payer policies fail to cover these tests. Greater utilization of NAAT for the diagnosis of vaginitis has the potential to improve the care of women seeking treatment for this prevalent condition and facilitate sexually transmitted infection testing without additional visits.
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