Rui Li1, Sascha R Ellington2, Romeo R Galang2, Scott D Grosse3, Zipatly Mendoza4, Stacey Hurst2, Yari Vale5, Eva Lathrop6, Lisa Romero2. 1. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: rli@hrsa.gov. 2. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA. 4. National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA. 5. University of Puerto Rico, Department of Gynecology and Obstetrics, San Juan, Puerto Rico. 6. Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA, USA.
Abstract
OBJECTIVE: During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a preimplementation hypothetical cost-effectiveness analysis (CEA). STUDY DESIGN: We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. RESULTS: The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV-associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. CONCLUSION: Z-CAN was likely cost-saving in the context of a public health emergency response setting.
OBJECTIVE: During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a preimplementation hypothetical cost-effectiveness analysis (CEA). STUDY DESIGN: We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. RESULTS: The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV-associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. CONCLUSION: Z-CAN was likely cost-saving in the context of a public health emergency response setting.
Authors: Carrie K Shapiro-Mendoza; Marion E Rice; Romeo R Galang; Anna C Fulton; Kelley VanMaldeghem; Miguel Valencia Prado; Esther Ellis; Magele Scott Anesi; Regina M Simeone; Emily E Petersen; Sascha R Ellington; Abbey M Jones; Tonya Williams; Sarah Reagan-Steiner; Janice Perez-Padilla; Carmen C Deseda; Andrew Beron; Aifili John Tufa; Asher Rosinger; Nicole M Roth; Caitlin Green; Stacey Martin; Camille Delgado Lopez; Leah deWilde; Mary Goodwin; H Pamela Pagano; Cara T Mai; Carolyn Gould; Sherif Zaki; Leishla Nieves Ferrer; Michelle S Davis; Eva Lathrop; Kara Polen; Janet D Cragan; Megan Reynolds; Kimberly B Newsome; Mariam Marcano Huertas; Julu Bhatangar; Alma Martinez Quiñones; John F Nahabedian; Laura Adams; Tyler M Sharp; W Thane Hancock; Sonja A Rasmussen; Cynthia A Moore; Denise J Jamieson; Jorge L Munoz-Jordan; Helentina Garstang; Afeke Kambui; Carolee Masao; Margaret A Honein; Dana Meaney-Delman Journal: MMWR Morb Mortal Wkly Rep Date: 2017-06-16 Impact factor: 17.586
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Authors: Lisa Romero; Rosa M Corrada-Rivera; Xavier Huertas-Pagan; Francisco V Aquino-Serrano; Ana M Morales-Boscio; Marizaida Sanchez-Cesareo; Edna Acosta-Perez; Zipatly Mendoza; Eva Lathrop Journal: J Public Health Manag Pract Date: 2022 Mar-Apr 01
Authors: Ashley N Smoots; Samantha M Olson; Janet Cragan; Augustina Delaney; Nicole M Roth; Shana Godfred-Cato; Abbey M Jones; John F Nahabedian; Jane Fornoff; Theresa Sandidge; Mahsa M Yazdy; Cathleen Higgins; Richard S Olney; Valorie Eckert; Allison Forkner; Deborah J Fox; Amanda Stolz; Katherine Crawford; Sook Ja Cho; Mary Knapp; Muhammad Farooq Ahmed; Heather Lake-Burger; Amanda L Elmore; Peter Langlois; Rebecca Breidenbach; Amy Nance; Lindsay Denson; Lisa Caton; Nina Forestieri; Kristin Bergman; Brian K Humphries; Vinita Oberoi Leedom; Tri Tran; Julie Johnston; Miguel Valencia-Prado; Stephany Pérez-González; Paul A Romitti; Carrie Fall; J Michael Bryan; Jerusha Barton; William Arias; Kristen St John; Sylvia Mann; Jonathan Kimura; Lucia Orantes; Brennan Martin; Leah de Wilde; Esther M Ellis; Ziwei Song; Amanda Akosa; Caroline Goodroe; Sascha R Ellington; Van T Tong; Suzanne M Gilboa; Cynthia A Moore; Margaret A Honein Journal: MMWR Morb Mortal Wkly Rep Date: 2020-01-24 Impact factor: 17.586