Provision of Contraceptive Implants in School-Based Health Centers: A Cost-Effectiveness Analysis

Abstract Objective : To evaluate the cost-effectiveness of providing contraceptive implants in school-based health centers (SBHCs) compared to the practice of referring adolescents to non-school-based health centers (NSBHCs) in New York City. Study Design : We developed a microsimulation model of teen pregnancy to estimate the cost-effectiveness of immediate provision of contraceptive implants at SBHCs over a 3-year time horizon. Model parameters were derived from both a retrospective chart review of patient data and published literature. The model projected the number of pregnancies as well as the total costs for each intervention scenario. The incremental cost-effectiveness ratio (ICER) was calculated using the public payer perspective, using direct costs only. Results : The healthcare cost of immediate provision of contraceptive implants at SBHCs was projected to be $13,719/person compared to $13,567/person for delayed provision at the referral appointment over three years. However, immediate provision would prevent 78 more pregnancies per 1,000 adolescents over 3 years. The ICER for implementing in-school provision was $1,940 per additional pregnancy prevented, which was less than the $4206.41 willingness-to-pay threshold. Sensitivity analyses showed that the cost-effectiveness conclusion was robust over a wide range of key model inputs. Conclusions : Provision of contraceptive implants in SBHCs compared to NSBHCs is cost-effective for preventing unintended teen pregnancy. Healthcare providers and policymakers should consider expanding this model of patient-centered healthcare delivery to other locations.