Use of emergency contraception and savings for National Health System in Italy
ESC Congress Library. Arisi E. May 11, 2018; 208262
Disclosure(s): I was a consultant for HRA Italy and Bayer.
Dr. Emilio Arisi
Dr. Emilio Arisi
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Abstract
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Objective: Evaluating use of EC and possible healthcare savings assessment for voluntary abortion (VA) in Italy, where LNG and UPA are both available. Design and methods: EC has mainly 2 goals: 1°- to avoid unplanned pregnancies; 2°- to decrease the expenses for VA. On this topic, pharmaco-economical evaluations have been carried out in the UK, France, the US and Spain. Some evaluations can be made for Italy as well. Background: UK (2013): If all women had taken UPA within the first 24-72 hours after intercourse, the UK NHS would have saved more than 4,3 million ₤ every year. France (2010):  More than 400.000 units of EC were reimbursed by the social health insurance fund; 90% of these units (362.273) were used by minors. The average cost for unintended pregnancy in minors in France is 1630 €. In 2010, using UPA instead of LNG as EC, 2862 (range 2355-7608) unintended pregnancies could be avoided in minors and almost 4 million € (3,1 € - 13,7 € million) in unintended pregnancy spending could have been saved.  USA (2013): Use of UPA instead of LNG will decrease the number of unwanted pregnancies by 37.589 (UPA 54.295 pregnancies; LNG 91.884 pregnancies), with a savings of $ 116,3 million per year. Spain (2012):  Estimated mean cost for each VA is 1670,74 €. A sensitivity analysis showed that the cost for avoiding a single additional pregnancy with UPA, compared to LNG, would be €107,74. Results in Italy: VAs is decreasing from 234.000 in 2008 to less than 90.000 in 2015. 'The greater decrease in VAs observed in 2015, especially between the second and third quarter, could be at least partially connected with the 21/04/15 decision of AIFA, which eliminates the necessity for a UPA prescription  for adults"   (Minister of Health, 2016). With 90.000 VAs yearly, the total cost of VAs could be calculated at around 135-180 millions €. During 2015, 390.000 ECs were used in Italy:  263.500 LNG (65%) + 136.500 UPA (35 %).  If all women had used UPA we would have saved 5.132 pregnancies and 7-10 million €. Conclusions: VA worldwide is a health and social burden. In Italy VA is decreasing each year. This reduction could also result in economic savings by investing in EC, better if in the EC  more effective in avoiding or reducing VA particularly in adolescents, as is the case in France.
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