A not so bitter pill

Australian research backs the cost effectiveness of Pharmacist-only oral contraceptive rescheduling

Down scheduling oral contraceptives to pharmacist-only would prove to be cost-effective, an Australian study claims.

In 2015 the TGA rejected oral contraceptive (OCP) reclassification to pharmacist-only due to safety concerns. At the time economic modelling on its cost-effectiveness was not undertaken, said the study authors. 

“At the time there was no facility to enable mandatory training and screening tool use in pharmacy, but now this is possible,” they said.

The researchers, from Macquarie University, Sydney, synthesised data from a range of sources, including recent consumer and health surveys and the Household, Income and Labour Dynamics in Australia (HILDA) survey.

Data from the HILDA survey showed that approximately 55% of Australian women aged between 15 and 49 years of age used contraception – with 33% using the OCP, the most common method.  

They calculated from this data that reclassifying OCPs to pharmacist-only would cost $46,910 million over 35 years compared with a cost of $50,274 million over the same period if they were to remain prescription-only.

The same data synthesis also found an overall increase in quality-adjusted life-years experienced by Australian women, as easier access could outweigh potential adverse events resulting from women not fully discussing their medical history or pharmacists not following the OCP questionnaire. 

“Economic modelling suggests that reclassifying OCPs to pharmacist-only will prevent unintended pregnancies, result in net health gains, and is likely to be considered cost effective by decision makers in Australia,” they said.

The researchers assumed that women must first consult a GP and receive a prescription for an OCP, and thereafter pharmacists would use the OCP Questionnaire at each subsequent request for OCPs.

The 2015 decision was prompted by safety concerns around risk of stroke or venous thromboembolism and the reduced use of other contraceptive methods, such as long-acting reversible contraceptives (LARCs).

However, since the rescheduling of OCPs to pharmacist-only in New Zealand, use of LARCs had actually increased as pharmacists were prompted by the OCP questionnaire to encourage women to consider their use. 

The study was published in the journal PharmacoEconomics.


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