Modeling the Impacts of Price of an Over-the-Counter Progestin-Only Pill on Use and Unintended Pregnancy among U.S. Women

Objective To model the impacts of out-of-pocket cost of an over-the-counter (OTC) progestin-only pill on use and associated unintended pregnancy among U.S. women. Study Design Using data from a 2015 nationally representative survey of 2,539 U.S. women aged 15 to 44 assessing interest in using an OTC progestin-only pill, we used discrete survival analysis and a Markov model to analyze women's likelihood of using of an OTC pill at different price points and by sociodemographic characteristics. We modeled the impact of product price on the potential total number of U.S. users and on unintended pregnancies in 1 year among adult women at risk of unintended pregnancy. Results In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8% decrease in unintended pregnancy in 1 year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5% decrease in unintended pregnancy among adults. Conclusions At low and no out-of-pocket cost, a large population of women in the United States might likely use an OTC progestin-only pill. A low retail price and insurance coverage are necessary to provide equitable access to this method for low-income populations across the United States, fill current gaps in contraceptive access, and potentially decrease unintended pregnancy.

目的 模拟非处方（OTC）仅含孕激素的避孕药的自付费用对美国女性的使用情况以及相关意外怀孕的影响。 研究设计 利用2015年对2539名15至44岁美国女性进行的具有全国代表性的调查数据（该调查评估了使用非处方仅含孕激素的避孕药的意愿），我们采用离散生存分析和马尔可夫模型，按社会人口学特征分析女性在不同价格点使用非处方避孕药的可能性。我们模拟了产品价格对美国潜在使用者总数以及对有意外怀孕风险的成年女性一年内意外怀孕情况的影响。 结果 在一个假设无自付费用的模型中，如果有非处方仅含孕激素的避孕药，超过1250万成年女性和175万青少年报告可能会使用。在成年女性中，这导致一年内意外怀孕估计减少8%。成年女性和青少年女性平均分别愿意支付15美元和10美元，这使得有710万成年使用者和130万青少年使用者，并且成年女性中意外怀孕估计减少5%。 结论 在低自付费用或无自付费用的情况下，美国大量女性可能会使用非处方仅含孕激素的避孕药。低零售价和保险覆盖对于为美国各地的低收入人群提供公平获取这种方法的途径、填补当前避孕获取方面的差距以及潜在减少意外怀孕是必要的。