Is the oral contraceptive pill Rx to OTC switch cost-effective?

Objectives: The oral contraceptive pill (OCP) is only available via Rx (prescription) in Australia. Studies have found that the requirement to obtain a prescription is a barrier to women initiating and continuing using the OCP. As a result, women may use a less effective contraceptive, such as the rhythm method, or no contraceptive.

Methods: A Markov model was used to synthesise data from a variety of sources. Health outcomes included pregnancies, pregnancy outcomes, adverse events and sexually transmitted infections (STIs). Costs included those related to GP and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events.

Results
It was predicted that switching OCP from Rx-to-OTC would decrease the number of women using no contraception by around 110,000 per annum, and increase the number of women on OCPs by around 184,000 per annum. As a result there would be around 54,000 fewer pregnancies per annum, and 27,000 fewer live births per annum. Switching OCPs from Rx-to-OTC would also increase the number of women experiencing STIs, notably chlamydia by around twelve per annum, and adverse events, notably depression by around 61 per annum and VTE by around twelve per annum. Overall, it was predicted that switching the OCP from Rx-to-OTC would result in a net health gain of 65,000 QALYs gained (or 0.012 QALYs gained per woman aged 15-49) and $4,500 million saved (or $805 per woman aged 15-49 years) over 35 years. Thus the OCP Rx-to-OTC switch would be more effective and cost-saving. The results were most sensitive to the probability of pregnancy in women not using contraception and not trying to conceive, but were robust to almost all other parameters.

Conclusions: The study demonstrated that the impact of Rx-to-OTC switch for OCP in the Australian market would be cost-effective, and in turn assist in reducing unintended pregnancies.