Presentation (CTI)

OBJECTIVES: Oral contraceptive pills (OCPs) are highly effective with perfect use, yet real-world adherence remains suboptimal due to access barriers such as prescription requirements, healthcare visits, and insurance limitations. These barriers contribute to unintended pregnancies and substantial healthcare expenditures. In July 2023, Opill containing progestin (norgestrel) was approved as the first over-the-counter (OTC) daily OCP the United States (US), potentially expanding the access. This research aims to evaluate the cost-effectiveness of OTC Opill access compared with prescription-based contraceptive methods among sexually active adult women aged 18-49 in the United States.
METHODS: A decision-tree model was developed from the healthcare payer perspective using TreeAge Pro. The model compared prescription-only contraceptive methods (oral contraceptives, long-acting reversible contraceptives, tubal ligation, and other methods) with an Opill access strategy over a one-year time horizon. Outcomes included pregnancy and pregnancy-related events (delivery, ectopic pregnancy, induced abortion, and spontaneous abortion). Costs were standardized to 2024 USD. A barrier-to-access adjustment was applied to estimate shifts in contraceptive use with OTC availability. Effectiveness was defined as pregnancy prevention. Incremental cost-effectiveness ratios (ICERs) were calculated using a willingness-to-pay threshold of $50,000 per effectiveness gained. One-way sensitivity analyses assessed parameter uncertainty.
RESULTS: The Opill access strategy resulted in a lower mean annual cost per individual ($650) compared with prescription- based contraception ($885), yielding a cost savings of $235. Effectiveness was equivalent across strategies (97% pregnancy prevention). Prescription-only contraception was economically dominated. Sensitivity analyses confirmed the robustness of findings, with pregnancy probability and contraceptive costs exerting the greatest influence on results.
CONCLUSIONS: OTC access to Opill represents a cost-saving and economically efficient strategy for contraception. Expanding OTC contraceptive access may reduce unintended pregnancies, alleviate healthcare costs, and improve reproductive health outcomes, particularly amid evolving reproductive health policy constraints in the United States.