Examining the effect of unintended pregnancy on health utility using four measures

Objectives: We measured women's preferences for avoiding an unintended pregnancy. We determined if young age (<25) was associated with lowest utility with an unintended pregnancy. Study Design: We conducted a cross sectional study of women presenting for hormonal contraception who did not desire a pregnancy. We used four techniques to elicit health prefences and calculate utilities for an unintended pregnancy: visual analog scale, and willingness to pay, time-tradeoff (TTO), and standard gamble. We dichotomized each measure to define lowest utility for each measure. We used predicted probabilities and multivariable logistic regression to estimate the association between age (≤25 vs ≥26 y) and lowest utility with an unintended pregnancy. Results: Our sample included 419 participants from four states. We found that younger age (≤25) was positively associated with reporting the lowest utility for unintended pregnancy. In absolute terms, with the visual analog scale, the probability that a woman 25 years or younger would have lower preference for an unintended pregnancy was 26.8% (95% CI 20.4–33.2%) versus (21.7% (95% CI 14.3–29.0%). Using the willingness to pay, the probability of the younger group having lower preference was 84.9% (CI 80.3–89.4%) compared to 57.3% (CI 49.3–65.3). With the TTO, Women 25 years old and younger had a 78.3% probability (CI 72.6–84.0%) of low utility on the TTO vs 48.9% (CI 40.9–56.9%) in the older group. With standard gamble, younger women had a 47.0% probability (CI 36.8–50.6%) versus 18.0% (CI 14.7–27.5%). Conclusions: Women of all ages report a decrease in health utility with unintended pregnancy. This decrease in health utility is greater among young women (age <25). Implications: Health utilities for unintended pregnancy can be used to guide cost effectiveness research and health policy.