Cost Effectiveness of Over-the-Counter Availability of Progestin-Only Contraceptive Pills in Abortion-Restrictive and Abortion-Protective Settings

OBJECTIVE: To determine the cost effectiveness of a policy change making a progestin-only contraceptive pill available over-the-counter (OTC). METHODS: We created a decision analytic model to determine the cost effectiveness of making an OTC progestin-only contraceptive pill available in the United States in two distinct policy environments: one in which abortion is legal and available and one in which abortion is restricted. Our theoretical population included 1,000,000 women at risk of unintended pregnancy over 1 year. We adopted the societal and payer perspective and obtained probabilities, utilities, and costs from the literature. We set the cost-effectiveness threshold at a standard $100,000 per quality-adjusted life-year (QALY). Our primary outcome was the incremental cost-effectiveness ratio. RESULTS: In a theoretical cohort of 1,000,000 women at risk of unintended pregnancy, having an oral contraceptive pill available OTC was a dominant strategy in both settings; it reduced costs and improved QALYs. In settings in which abortion was available, having an OTC progestin-only contraceptive pill was associated with a $976-million reduction in costs and an increase of 14,153 QALYs. An OTC progestin-only contraceptive pill strategy would no longer be cost effective if more than 70% of OTC progestin-only contraceptive pill users discontinued usage; OTC progestin-only contraceptive pills would be cost effective for insurers to cover until the monthly cost exceeds $250 per pill pack in an abortion-protective setting. CONCLUSION: The availability of an OTC progestin-only contraceptive pill is a cost-effective strategy in abortion-protective and abortion-restrictive settings.