Volume 23, Number 1—January 2017
Research
Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016
, Katharine B. Simmons, Jeanne Bertolli, Brenda Rivera-Garcia, Shanna Cox, Lisa Romero, Lisa M. Koonin, Miguel Valencia-Prado, Nabal Bracero, Denise J. Jamieson, Wanda Barfield, Cynthia A. Moore, Cara T. Mai, Lauren C. Korhonen, Meghan T. Frey, Janice Perez-Padilla, Ricardo Torres-Muñoz, and Scott D. Grosse
Table 2
Zika virus–associated microcephaly cases and costs, as well as additional costs associated with unwanted pregnancies, with and without intervention to increase access to contraception to women during the Zika virus outbreak, Puerto Rico, 2016, in main scenario*†‡
| Parameter | Without intervention | With intervention | Difference |
|---|---|---|---|
| Prevention of ZAM and Zika virus–associated cost | |||
| Total no. ZAM cases | 99 | 74 | −25 |
| No. pregnancy terminations | 28 | 21 | −7 |
| No. stillbirths | 7 | 5 | −2 |
| No. live births | 64 | 48 | −16 |
| Cost of family planning services (under intervention also includes program cost) | $38,269,679 | $71,738,133 | $33,468,454 |
| Total Zika virus–associated cost | $256,578,162 | $191,422,342 | –$65,155,820 |
| Costs of extra testing and monitoring for Zika virus during pregnancy and for infants exposed in utero during Zika virus outbreak§ | $11,125,061 | $8,303,158 | –$2,821,903 |
| Direct costs of ZAM¶ | $245,453,101 | $183,119,184 | –$62,333,917 |
| Pregnancy terminations | $139,343 | $103,956 | –$35,387 |
| Stillbirths | $40,025 | $29,861 | –$10,165 |
| Live births | $245,273,733 | $182,985,368 | –$62,288,366 |
| Cost savings from Zika virus–associated cost avoided only# |
–$31,687,366 |
||
| Prevention of unwanted pregnancies | |||
| No. of unwanted pregnancies** | 11,995 | 8,949 | −3,046 |
| No. induced abortions | 3,385 | 2,525 | −860 |
| No. spontaneous abortions and fetal deaths | 1,679 | 1,253 | −426 |
| No. unwanted live births | 6,856 | 5,117 | −1,739 |
| Medical cost for unwanted pregnancy | $159,074,573 | $118,722,504 | –$40,352,069 |
| Net cost savings from avoiding both Zika virus–associated cost and unwanted pregnancy cost†† | –$72,039,435 | ||
*ZAM, Zika virus–associated microcephaly.
†The numbers in the columns and rows might not exactly match because of rounding.
‡Target population size: 163,000 women who do not intend to become pregnant during Zika virus outbreak. Women of reproductive age in Puerto Rico who are sexually active with a male partner, fertile, not desiring pregnancy, and not using permanent contraception methods (e.g., tubal ligation and vasectomy).
§Only including cost of testing for Zika virus and monitoring for exposed infants without ZAM; testing costs for infants with ZAM are included in the direct costs of ZAM.
¶From healthcare system perspective, includes direct medical and medical-related costs, including supportive care for persons with ZAM, even if the cost might not be paid by healthcare payers or delivered by healthcare providers.
#Total Zika virus–associated cost avoided (absolute value) minus the additional cost of family planning service under intervention compared with no intervention.
**Unwanted pregnancies which are not desired in the future (assuming 60% of unintended pregnancies are mistimed), irrespective of Zika virus infection
††Absolute value of net medical cost for unwanted pregnancy plus absolute value of net cost savings from Zika virus–associated costs avoided.