{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:39:48Z","timestamp":1753893588153,"version":"3.41.2"},"reference-count":26,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JHEOR"],"abstract":"<jats:p>Background: A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods.\n\nObjectives: This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period.\n\nMethods: A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure.\n\nResults: Reversible contraception costs in Spain amount to \u20ac12.5 billion over a 5\u2013year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women\u2019s age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over \u20ac7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring \u20ac2427.8, patch \u20ac2402.6, condom \u20ac2060.1 and COC \u20ac1895.1; while LARC methods are the most economic option per women: LNG-IUS20 \u20ac630.4, copper IUD \u20ac658.2, LNG-IUS12 \u20ac703.8, intramuscular injectable \u20ac907.8 and implant \u20ac940.5.\n\nConclusions: LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.<\/jats:p>","DOI":"10.36469\/9785","type":"journal-article","created":{"date-parts":[[2019,9,24]],"date-time":"2019-09-24T18:51:51Z","timestamp":1569351111000},"page":"63-74","source":"Crossref","is-referenced-by-count":5,"title":["Economic Burden of Contraception Management in Spain"],"prefix":"10.36469","volume":"6","author":[{"given":"Inmaculada","family":"Parra Ribes","sequence":"first","affiliation":[{"name":"Unidad de Salud Sexual y Reproductiva de Sueca, Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Jos\u00e9","family":"Rasc\u00f3n Poza","sequence":"additional","affiliation":[{"name":"Centro de Salud Mediterr\u00e1neo, Almer\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezequiel","family":"P\u00e9rez Campos","sequence":"additional","affiliation":[{"name":"Hospital de Requena, Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Bugella Yudice","sequence":"additional","affiliation":[{"name":"Centro Planificaci\u00f3n de Getafe, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Jes\u00fas","family":"Rodr\u00edguez Domingo","sequence":"additional","affiliation":[{"name":"Centro ASSIR Viladecans, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22273","published-online":{"date-parts":[[2018,4,16]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Lete I, Hassan F, Chatzitheofilou I, et al. Direct costs of unintended pregnancy in Spain. Eur J Contracept Reprod Heal Care. 2015;20(4):308-318.","DOI":"10.3109\/13625187.2015.1028617"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Due\u00f1as JL, Lete I, Bermejo R, et al. Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007. Contraception. 2011;83(1):82-87.","DOI":"10.1016\/j.contraception.2010.05.010"},{"key":"ref2","unstructured":"Spanish Society of Contraception. Contraception survey 2016. http:\/\/sec.es. Accessed April 2017."},{"key":"ref3","unstructured":"National Statistics Institute (INE). http:\/\/www.ine.es\/jaxi\/Tabla.htm?path=\/t20\/p278\/p01\/2016-2066\/l0\/&file=01001.px&L=0. Accessed April 2017."},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Serrano I, Doval J, Lete I, et al. Contraceptive practices of women requesting induced abortion in Spain: A cross-sectional multicentre study. Eur J Contracept Reprod Heal Care. 2012;17(3):205-211.","DOI":"10.3109\/13625187.2012.670889"},{"key":"ref5","unstructured":"B.O.J.A. Official Bulletin of the Andalusian Autonomous Government. Order of October. 2005:46-83. http:\/\/www.juntadeandalucia.es\/boja\/2005\/210\/d28.pdf."},{"key":"ref6","unstructured":"Official Gazette of the Autonomous Government of Catalonia. Order SLT\/30\/2013, February 20, 2013. 2013:10695-10862."},{"key":"ref7","unstructured":"Official Gazette of Madrid. Order 731\/2013, September 6, 2013. 2017:8-30."},{"key":"ref8","unstructured":"National Statistics Institute (INE). Update of income with the general CPI (IPC base system 2016) for complete annual periods. http:\/\/www.ine.es\/calcula\/index.do?L=0. Accessed April 2017."},{"key":"ref9","unstructured":"BotPlus Web 2.0., General Council of Spanish Pharmacists. https:\/\/botplusweb.portalfarma.com\/. Accessed February 2016."},{"key":"ref10","unstructured":"Official State Gazette (BOE). Article 8. May 2010:48-50. https:\/\/www.boe.es\/diario_boe\/txt.php?id=BOE-A-2010-8228."},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404.","DOI":"10.1016\/j.contraception.2011.01.021"},{"key":"ref12","unstructured":"Annual Number of Induced Abortions: Voluntary Termination of Pregnancy, 2014. Spanish Ministry of Health, Social Services and Equality; 2014. http:\/\/www.msssi.gob.es\/profesionales\/saludPublica\/prevPromocion\/embarazo\/tablas_figuras.htm. Accessed April 28, 2017."},{"key":"ref13","unstructured":"Ministry of Health, Social Services and Equality. Certificates of Discharge of the National Health System Register. CMBD. State Regulation http:\/\/www.msc.es\/en\/estadEstudios\/estadisticas\/cmbd.htm."},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Lete I, P\u00e9rez-Campos E. Differences in contraceptive use between Spanish female healthcare providers and Spanish women in the general population aged 23 to 49 years: the HABITS Study. Eur J Contracept Reprod Heal Care. 2014;19(3):161-168.","DOI":"10.3109\/13625187.2014.893424"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Parks C, Peipert J. Eliminating Health Disparities in Unintended Pregnancy with Long-Acting Reversible Contraception (LARC). Am J Obs Gynecol. 2016;214(6):681-688.","DOI":"10.1016\/j.ajog.2016.02.017"},{"key":"ref16","unstructured":"Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15-44: United States, 2011-2013. 2014;(173):1-8."},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Whitaker AK, Sisco KM, Tomlinson AN, Dude AM, Martins SL. Use of the intrauterine device among adolescent and young adult women in the United States from 2002 to 2010. J Adolesc Heal. 2013;53(3):401-406.","DOI":"10.1016\/j.jadohealth.2013.04.011"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Haimovich S. Profile of long-acting reversible contraception users in Europe. Eur J Contracept Reprod Heal Care. 2009;14(3):187-195.","DOI":"10.1080\/13625180902741436"},{"key":"ref19","unstructured":"WHO. World Health Organization. From Evidence to Policy: Expanding Access to Family Planning Strategies to increase use of long-acting and permanent contraception. 2012. http:\/\/apps.who.int\/iris\/bitstream\/10665\/75161\/1\/WHO_RHR_HRP_12.20_eng.pdf?ua=1."},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"ACOG Committee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice; Long-Acting Reversible Contraception. Work Group Obs Gynecol. 2009;114(450):1434-1438.","DOI":"10.1097\/aog.0b013e3181c6f965"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Parrilla JJ, Coll C, Bajo JM, Balasch J, Calaf J, A C, et al. Analysis of compliance with oral contraception in Spain. Eur J Contracept Reprod Heal Care. 1996;1(4):337-347.","DOI":"10.3109\/13625189609150680"},{"key":"ref22","unstructured":"Seventh Contraception Survey in Spain, 2011. Bayer HealthCare; 2011. http:\/\/www.acaive.com\/pdf\/Encuesta-anticoncepcion-Equipo-Daphne-26-10-11-2.pdf. Accessed April 2016."},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Creanga AA, Acharya R, Ahmed S, Tsui AO. Contraceptive discontinuation and failure and subsequent abortion in Romania: 1994-99. Stud Fam Plann. 2007;38(1):23-34.","DOI":"10.1111\/j.1728-4465.2007.00113.x"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Palanivelu LM, Oswal A. Contraceptive practices in women with repeat termination of pregnancies. J Obs Gynaecol. 2007;27(8):832-834.","DOI":"10.1080\/01443610701711482"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Ingham R, Lee E, Clements SJ, Stone N. Reasons for second trimester abortion in England and Wales. Reprod Heal Matters. 2008;16(31 Suppl):18-29.","DOI":"10.1016\/s0968-8080(08)31375-5"}],"container-title":["Journal of Health Economics and Outcomes Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/pmid\/32685572\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T14:40:26Z","timestamp":1748875226000},"score":1,"resource":{"primary":{"URL":"https:\/\/jheor.org\/article\/9785-economic-burden-of-contraception-management-in-spain"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,16]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,1,29]]},"published-print":{"date-parts":[[2018,1,29]]}},"URL":"https:\/\/doi.org\/10.36469\/9785","archive":["Portico","Portico","Portico"],"relation":{},"ISSN":["2327-2236"],"issn-type":[{"type":"electronic","value":"2327-2236"}],"subject":[],"published":{"date-parts":[[2018,4,16]]},"article-number":"9785"}}