Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs

Maria Rodriguez, Alyssa Hersh, Lorinda B. Anderson, Daniel M. Hartung, Alison Edelman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies. CONCLUSION: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.

Original languageEnglish (US)
Pages (from-to)1238-1246
Number of pages9
JournalObstetrics and gynecology
Volume133
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Medicaid
Contraception
Pharmacists
Prescriptions
Contraceptive Agents
Costs and Cost Analysis
Pregnancy
Quality-Adjusted Life Years
Cost-Benefit Analysis
Insurance Claim Review
Standard of Care
Quality of Life

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs. / Rodriguez, Maria; Hersh, Alyssa; Anderson, Lorinda B.; Hartung, Daniel M.; Edelman, Alison.

In: Obstetrics and gynecology, Vol. 133, No. 6, 01.06.2019, p. 1238-1246.

Research output: Contribution to journalArticle

@article{2f4542e20d28487f9b70b18823f71bf2,
title = "Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs",
abstract = "OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10{\%} less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies. CONCLUSION: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.",
author = "Maria Rodriguez and Alyssa Hersh and Anderson, {Lorinda B.} and Hartung, {Daniel M.} and Alison Edelman",
year = "2019",
month = "6",
day = "1",
doi = "10.1097/AOG.0000000000003265",
language = "English (US)",
volume = "133",
pages = "1238--1246",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs

AU - Rodriguez, Maria

AU - Hersh, Alyssa

AU - Anderson, Lorinda B.

AU - Hartung, Daniel M.

AU - Edelman, Alison

PY - 2019/6/1

Y1 - 2019/6/1

N2 - OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies. CONCLUSION: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.

AB - OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies. CONCLUSION: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.

UR - http://www.scopus.com/inward/record.url?scp=85066974147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066974147&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000003265

DO - 10.1097/AOG.0000000000003265

M3 - Article

C2 - 31135740

AN - SCOPUS:85066974147

VL - 133

SP - 1238

EP - 1246

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 6

ER -