Economic Burden of Contraception Management in Spain

Abstract

Background: A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. Objectives: This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. Methods: A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. Results: Reversible contraception costs in Spain amount to €12.5 billion over a 5–year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women’s age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. Conclusions: LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.

Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020)

“…Despite its recommendation and of being a more economical option [26], the use of LARCs continues to be relatively low when compared to SARCs, a fact that has also been stated in studies conducted in other European countries such as Sweden, where 2 out of 10 women used LARCs [7]. It continues to be a more frequent contraception option in women aged over 30 years old [3].…”

“…However, access to counselling on contraception and sexual education are not uniformly egalitarian throughout the country, as they depend on regional policies [19]. Thus, while they are practically fully funded in some regions, there are deficits in others [26].…”

Willingness to pay for short- and long-acting contraceptives among female adolescents and their parents in Brazil:a pilot study

“…Indeed, a study conducted in Spain also showed that young women, aged up to 29 years, preferred to use SARC methods, such as combined oral contraceptive, vaginal ring, and male condom, for contraception. (15) This result highlights the importance of broader education and easier access to LARC methods to the population, especially young women, to prevent unintended pregnancies.…”