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Volume 23, Number 1—January 2017

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

Rui LiComments to Author , 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
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. Li, K.B. Simmons, J. Bertolli, S. Cox, L. Romero, L.M. Koonin, D.J. Jamieson, W. Barfield, C.A. Moore, C.T. Mai, L.C. Korhonen, M.T. Frey, J. Perez-Padilla, S.D. Grosse); Puerto Rico Department of Health, San Juan, Puerto Rico (B. Rivera-Garcia, M. Valenica-Prado, R. Torres-Muñoz); University of Puerto Rico and Puerto Rico Section of the American College of Obstetricians and Gynecologists, San Juan (N. Bracero)

Main Article

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#

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.

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Page created: December 14, 2016
Page updated: December 14, 2016
Page reviewed: December 14, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.