Implications of employer coverage of contraception: Cost‐effectiveness analysis of contraception coverage under an employer mandate

Abstract

Objectives Mandatory employer-based insurance coverage of contraception in the U.S. has been a controversial component of the Affordable Care Act (ACA). Prior research has examined the cost effectiveness of contraception in general; however, no studies have developed a formal decision-model in the context of the new ACA provisions. As such, this study aims to estimate the relative cost effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions. Study Design A decision-tree was developed from the employer perspective to simulate pregnancy costs and outcomes associated with insurance coverage. Method-specific estimates of contraception failure rates, outcomes, and costs were derived from the literature. Uptake by marital status and age was drawn from a nationally-representative database Results Providing no contraception coverage resulted in 33 more unintended pregnancies per 1000 women (95% Confidence Range: 22.4; 44.0). This subsequently significantly increased the number of unintended births and terminations. Total costs were higher among uninsured women owing to higher costs of pregnancy outcomes. The effect of no insurance was greatest on unmarried women 20–29 years old. Conclusions Denying female employees full coverage of contraceptives increases total costs from the employer perspective, as well as the total number of terminations.

Development of a pharmacoeconomic registry: an example using hormonal contraceptives

“…Table 1 presents a summary of the CEA, CUA, CBA, CMA, CA and QOL studies. From the CEA and CUAs, ten studies were decision-tree models [ 27 , 31 , 38 – 40 , 42 , 48 , 49 , 51 , 52 ] and eleven were Markov models [ 30 , 32 – 34 , 37 , 41 , 44 – 47 , 50 ] and one was conducted using a systematic review and meta-analysis as part of a health technology assessment submission [ 28 ]. The remaining studies determined cost-effectiveness using real-world data or observational studies [ 22 , 29 , 35 , 36 , 43 ] or utilized a simple methodology considering costs and failure rates of each method [ 24 – 26 ] or a cost equation for clinical outcomes [ 23 ].…”

“…LARC methods become cost-saving relative to SARC methods within 3 years of usage even if they are not used for their full duration of efficacy. 21 Canestaro, 2017 (USA) [ 42 ] Estimate the relative cost effectiveness of insurance coverage of contraception under employer-sponsored insurance coverage taking into consideration newer regulations allowing for religious exemptions. Full contraceptive coverage through an employer-sponsored private health insurance plan (OCs, tubal ligation, IUD, injectable, vaginal ring, transdermal patch, implant) versus no contraceptive coverage Employer 1 year Costs per woman, number of unintended pregnancies Not providing contraception coverage resulted in greater number of unintended pregnancies resulting in higher total costs among uninsured women.…”

“…Three studies considered adolescent contraceptive provision [ 26 , 38 , 60 ] and one focused on active-duty military women [ 39 ]. Two studies considered the underinsured, quantifying the impact of expansion of contraceptive coverage through Affordable Care Act (ACA) [ 42 , 46 ].…”

The American Academy of Nursing on policy proposed healthcare policy changes threaten women's health

“…For every 1 million women of an age cohort, removal of insurance coverage for contraception would result in over 33,000 additional unintended pregnancies, a portion of which would result in abortion, all due to limitations in access to highly effective contraception (Canestaro, Vodicka, Downing, & Trussell, 2017). In short, reverting to prior barriers to access sexual and reproductive health care for women and girls will result in more unintended pregnancies, more medically induced abortions, decreased access to primary care services, and significantly increased total costs from both the societal and employer/payor perspectives.…”

Ongoing Implementation Challenges to the Patient Protection and Affordable Care Act’s Contraceptive Mandate

“…On the other hand, contraceptive coverage without cost sharing could result in greater uptake, continued use of highly effective methods, subsequent decreases in premiums, and overall cost savings for insurers, health systems, and society. 17 Research is needed to evaluate the benefits and costs of the mandate on insurance premiums and other cost-effectiveness indicators. Regardless, all key stakeholders should have an active voice regarding which potential expanded benefits to prioritize.…”