Framework for oral contraceptive Rx to OTC switch in Australia

Activity: Talk or presentationPresentation


Background and Objective Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian
Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription
to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some
women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and
some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate
the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only.
Perspective Healthcare system.
Setting Australian primary care.
Methods A Markov model was used to synthesise data from a variety of sources. The model included all Australian women
aged 15–49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated
using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use
after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic
pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial
infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner
and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All
costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs.
Results Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million
over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining
prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found
that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed.
Conclusion Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.
Period21 Sept 2017
Event titleAnnual Australian Health Economics Society Conference
Event typeConference
LocationSydney, AustraliaShow on map
Degree of RecognitionNational