Author Topic: One Simple Fix Could Prevent Unwanted Pregnancies and Save Millions of Dollars  (Read 253 times)

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Online Desert Fox

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In simple terms, provide a year of birth control pills at one time

https://www.motherjones.com/politics/2019/07/one-simple-fix-could-prevent-unwanted-pregnancies-and-save-millions-of-dollars/
Quote
A new study finds that providing women with a yearlong supply of oral contraceptive birth control—rather than the typical three-month supply—could be the key to millions of dollars in health care savings and fewer unintended pregnancies.

Researchers at the Department of Veterans Affairs and the University of Pittsburgh found that supplying women in the VA with a yearlong supply of oral contraceptive pills would prevent an estimated 583 unintended pregnancies annually. The change would also save the government $2 million a year by reducing spending on pregnancy-related care, such as prenatal and newborn care, which would otherwise be covered by the VA health insurance.

The researchers used mathematical modeling based on existing data from the VA healthcare system, not clinical trials, to come to their conclusions, since the VA does not currently provide yearlong supplies. They found that gaps between oral contraceptives refills caused by shorter supply windows are a major factor in the prevalence of unintended pregnancies.

“Missing only a couple days of pills can lead to an unintended pregnancy,” says Colleen Judge-Golden, a co-author of the study. “When you just give a year’s supply of contraception up front to women, those women actually have a reduction in the amount of gap in their medication coverage.”
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Offline 2397

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As in, in one packet? Or apparently, per pharmacy visit.

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Like the VA, most health insurers currently cap the number of pills that women can pick up at one time without being charged, typically at 30, 60, or 90 days of coverage. Ostensibly, this is to prevent potential pill wastage: Insurers are concerned women may switch contraceptives during the year or stop taking them, which would leave the insurers paying for unused medication. However, Judge-Golden believes this particular concern misses the costs of unintended pregnancies.

“This is not a completely irrational thing to be worried about, but what our analysis and other studies have actually found is that those concerns are really overshadowed by the prevention of pregnancy,” she says. “Pregnancies cost a lot more than pills.”

From what I've seen, ~3 months/100 pills is the maximum in a single packet for most medicines, not including refills. But in Norway, prescription renewals are a matter of a free phone call to the doctor's office and then you'll have it updated within one workday. The only challenge is remembering to do that ahead of running out.

Although I can also see the pill wastage issue. Not on cost, but on drugs spilling into the environment. Has that been looked at, including how much medicine people deliberately throw in the trash or sewage, depending on how much of it they can pick up at a time?

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In addition, she notes, the VA does not provide coverage for abortion services, even when the mother’s health is at risk. “So I think the high prevalence of chronic medical and mental conditions, coupled with no abortion coverage, really makes it critical that we really support these women’s use of contraception,” she says.

Yeah, having an anti-choice government and political legacy does make things more complicated. How about a trial run of free abortions, see how that affects overall risks and costs? It's not really something you can overuse or waste, so using cost to discourage it doesn't make sense to me.
« Last Edit: July 21, 2019, 03:04:11 AM by 2397 »

Offline stands2reason

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I was going to make some comment about how it was about shoddy healthcare. But this is a VA (Veterans Affairs) study. So it only looks at veterans and spouses & dependents thereof. Meaning, it's not just access to healthcare that causes such discrepancies.

But actually, that's not even the beginning of the weirdness. That article doesn't link to the study, it links to a press release. A press release that doesn't link to the study either, but gives the award number (TL1TR001858):

This appears to be the same study they are referring to, but actual study appears to be something entirely different. (https://www.sciencedirect.com/science/article/abs/pii/S1049386718300628)

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Abstract
Background

Although pregnancy intention is strongly associated with contraceptive use, little is known about the interaction between pregnancy intention and attitude, or how they jointly affect contraceptive use.
Methods

Cross-sectional data from a national survey of women veterans who receive care within the Veterans Affairs Healthcare System were used to examine relationships among pregnancy intention (in next year, in >1 year, never, not sure), attitude toward hypothetical pregnancy (worst thing, neutral, best thing), and contraceptive use among women at risk for unintended pregnancy. Bivariate and multivariable analyses assessed associations between pregnancy intention and attitude, both separately and jointly, with contraceptive use. Multinomial regression assessed the relationship of intention and attitude with contraceptive method effectiveness.
Results

Among 858 women at risk of unintended pregnancy, bivariate analysis demonstrated that pregnancy intention and attitude were associated, but not perfectly aligned. In logistic regression models including both variables, intention of never versus in next year (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.34–5.75) and attitude of worst thing versus best thing (aOR, 2.86; 95% CI, 1.42–5.74) were each positively associated with contraception use. Among women using contraception, intention of never (aOR, 3.17; 95% CI, 1.33–7.59) and attitude of worst thing (OR, 2.09; 95% CI, 1.05–4.17) were associated with use of highly effective (e.g., intrauterine devices and implants) versus least effective (e.g., barrier) methods.
Conclusions

These findings support prior research suggesting that pregnancy intention alone does not fully explain contraceptive behaviors and imply that attitude toward pregnancy plays an important role in shaping contraceptive use independent of pregnancy intentions.

...

    This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development (VA Merit Award IIR 12–124, PI: Sonya Borrero); Colleen Judge is supported by the National Center For Advancing Translational Sciences of the National Institutes of Health (Award Number TL1TR001858, PI: Wishwa Kapoor). The views and opinions of authors expressed herein do not necessarily state or reflect those of the Department of Veterans Affairs or the United States Government. No competing financial interests exist.

Offline CarbShark

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Found it:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737751

Original Investigation Health Care Policy and Law
July 8, 2019
Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System

Quote
The 12-month OCP dispensing option, modeled from the VA health system perspective using a cohort of 240 309 women, resulted in anticipated VA annual cost savings of $87.12 per woman compared with the cost of 3-month dispensing, or an estimated total savings of $2 117 800 annually. Cost savings resulted from an absolute reduction of 24 unintended pregnancies per 1000 women per year with 12-month dispensing, or 583 unintended pregnancies averted annually.


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Online bachfiend

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It seems sensible to be able to get a prescription for a year’s supply of oral contraceptives.  I’m also on a hormone preparation - thyroxine for hypothyroidism.  My doctor prescribes me 200 x 100 microgram tablets plus 200 x 75 microgram tablets, plus one repeat of each, so that I can take 175 micrograms per day, meaning that I have enough for 400 days.  But I need to have my thyroid function tested by blood tests yearly to ensure I’m still euthyroid, and not hypothyroid or hypothyroid, so that’s when I get a new prescription.  Yearly.

It’s also the time my doctor checks me for other health concerns.
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Offline stands2reason

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I skimmed through the study to see if it specified, but I think birth control pills are the same synthetic estrogen used for post-menopausal & trans hormone therapy. Estradiol typically has a shelf life of a few years. Again, as the study points out, there wasn't any reason not to do this other than the department policy of 3-month limit on prescription.

On a side note, due to the issues the VA has been having, wonder if reduced frequency of script refills would affect overhead significantly? I mean, sure wouldn't want them to use this policies for opiates...

Offline lonely moa

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Vasectomy. Job done.
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