New research in: Patch is cost-effective
Since the transdermal contraceptive (Ortho Evra, Ortho-McNeil Pharmaceutical, Raritan, NJ) was approved by the Food and Drug Administration in 2001, it has gained an increasing share of the contraceptive option mix offered by family planning providers. New research indicates that use of the contraceptive patch results in greater cost savings and reductions in pregnancy, compared with combination oral contraceptives (OCs), due to improved compliance by patients.1
Such news may aid family planning administrators when making decisions in stocking the formulary mix offered in their clinics. The patch has proven popular with patients — more than 90% of 2004 respondents to the Contraceptive Technology Update Contraception Survey indicated their facilities already were offering or implementing the method — and administrators have had to make adjustments in their supplies to keep up with the demand.
At Planned Parenthood Springfield (IL) Area, clinicians offer all methods to suit individual preferences and lifestyles, then allow patients to decide what works best, reports Stephani Cox, APN, CNP, DPS, director of patient services.
"Our formulary reflects all methods now; however, I do see that we are offering fewer different oral contraceptive choices as the demand for other methods increases," she notes.
Review the research
Two previous randomized comparative trials of the patch and OCs showed that the patch’s efficacy was equivalent to that of the Pill and that compliance was greater with the patch.2,3 In particular, there was a bigger difference in compliance in younger women, observes Frank Sonnenberg, MD, lead author of the new research and professor of medicine at the University of Medicine and Dentistry, New Jersey’s Robert Wood Johnson Medical School in New Brunswick.
Younger women are known to be more noncompliant with oral contraceptives than older women; in the trials, use of the patch seemed to be relatively constant across age groups, says Sonnenberg. In all age groups, researchers found use was at least equivalent, but overall was better for the patch and especially better in the youngest age groups, he notes.
Research published in 2004 indicated that the weekly change schedule of the contraceptive patch is associated with a significantly greater proportion of cycles in which there is perfect dosing compared to an OC.4 In performing the new analysis, researchers set out to examine such implications of increased perfect use on the cost-effectiveness of the contraceptive patch compared with the Pill.
In designing the study, researchers compared the patch with low-estrogen OCs and worked from the assumption that the risks of developing a medical condition during use would be the same for the two hormonal methods. Using a pharmacoeconomic model, both methods were compared with a hypothetical reference case of contraception nonuse. The base-case model considered women, ages 15 to 50, in average health in a long-term, mutually monogamous, heterosexual relationship.
The base-case analysis showed that use of the patch resulted in a savings of $249 and 0.03 pregnancies per woman over two years compared with the Pill. Researchers concluded that patch use would offer cost savings compared with Pill use, due to reduced costs of pregnancy.
"It is pretty clear that if both methods cost the same, then the patch would save money because it would result in fewer pregnancies, and that is especially true in the youngest age groups," says Sonnenberg. "In our analysis, we looked at the implications of various alternative scenarios; for example, if you were comparing the patch with generic oral contraceptives vs. brand-name ones, the savings would be a little bit less because the patch would cost more than the oral contraceptive, but even there, using an average for generic for oral contraceptives, the difference in our estimated effectiveness still resulted in an estimated cost savings."
References
1. Sonnenberg FA, Burkman RT, Speroff L, et al. Cost-effectiveness and contraceptive effectiveness of the transdermal contraceptive patch. Am J Obstet Gynecol 2005; 192:1-9.
2. Hedon B, Helmerhorst FM, Cronje HS, et al. Comparison of efficacy, cycle control, compliance, and safety in users of a contraceptive patch vs. an oral contraceptive. Int J Gynecol Obstet 2000; 70(suppl 1):78.
3. Audet M-C, Moreau M, Koltun WD, et al. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: A randomized controlled trial. JAMA 2001; 285:2,347-2,354.
4. Archer DF, Cullins V, Creasy GW, et al. The impact of improved compliance with a weekly contraceptive transdermal system (Ortho Evra) on contraceptive efficacy. Contraception 2004; 69:189-195.
New research indicates that use of the contraceptive patch results in greater cost savings and reductions in pregnancy, compared with combination oral contraceptives, due to improved compliance by patients.
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