Cost-effectiveness of different contraceptive methods to avoid unintended pregnancy among adolescents in China: A modeling analysis based on decision-tree modle

Cost-effectiveness of different contraceptive methods to avoid unintended pregnancy among adolescents in China: A modeling analysis based on decision-tree modle | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-effectiveness of different contraceptive methods to avoid unintended pregnancy among adolescents in China: A modeling analysis based on decision-tree modle Weihua Luo, Di Wang, Gan Xu, Liangru Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5393510/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The problem of unintended pregnancy among adolescent spreads worldwide. In this study, a decision-tree model was constructed to analyze the cost and effectiveness of different contraceptive methods in Chinese adolescents to avoid unintended pregnancy. Methods From a healthcare system perspective, evaluate the cost and effectiveness of combined oral contraceptive (COC), intrauterine device (IUD), levonorgestrel intrauterine system (LNG-IUS) and subdermal implant contraceptive methods used by 14.88 million women aged 15–24 years with contraceptive needs within 5 years in 2023. The cost parameters are derived from the China Medical Information Platform and healthcare service price literature. Effectiveness refers to avoided pregnancies, abortions, and births. The clinical parameters are derived from the WHO and published literature. Cost-effectiveness analysis is used to determine whether contraception measures are economical. Univariate sensitivity analysis and probabilistic sensitivity analysis verify the robustness of the model. Results The cost of IUD is the lowest, and subdermal implant has the highest number of unintended pregnancies. The cost-effectiveness ratio shows that IUD has the best contraceptive effect, and it costs RMB 369.67 to avoid accidental pregnancy among adolescents. Compared with COC, IUD has significant contraceptive advantages and can achieve better clinical results at lower cost. LNG-IUS and subdermal implant are economical when compared with COC, with ICER of 7556.78 and 12271.85, both of which are lower than the GDP per head of China. Conclusions Faced with the growing demand for contraception among adolescents and high incidence of unintended pregnancies, adolescents can be encouraged to adopt LARC methods, especially IUD. Adolescents Contraceptive methods Unintended pregnancies Cost-effectiveness analysis Decision-tree model Figures Figure 1 Figure 2 Background The problem of unintended pregnancy among adolescents spreads worldwide. It is estimated 21 million girls aged 15-19 pregnant annually in developing countries, and nearly 12 million of them give birth[ 1] . Compared with women aged 25-49, adolescents (15-24 years) account for 26.5% of the global unmet need for contraception, leading to a significant number of unintended pregnancies due to the lack of or incorrect use of contraceptive methods[ 2] . With the initial sexual activity among adolescents occurred at younger ages, and the physical and mental health caused by unexpected pregnancies affects their future development seriously[ 3] . Young women also face a series of challenges such as educational disruption, social discrimination, career retardation, and challenges to economic independence[ 4][5] . In China, 51.2% of adolescents aged 15-24 have their first sexual behavior without using any contraceptive measures, resulting in a pregnancy rate of 3%, which increases at a rate of 6.9% per year[ 6] . In the past 20 years, the age of first sexual experience among Chinese adolescents has been advanced[ 7] , while the age of marriage and childbearing has been postponed, which means that unintended pregnancy often ends in induced abortion among adolescents[ 8] . Studies show that the proportion of young, unmarried, and childless women induced abortion is continuously increasing, with a significant increase in high-risk and repeated abortions among those under 20, also, unmarried adolescents under the age of 24 account for more than 40% of the total number of abortions in China every year, with nearly 20% having experienced repeated abortions[ 9] . Adolescence is a critical period for sexual health education and contraceptive intervention. Many countries have implemented various measures to popularize contraceptive knowledge and provide contraceptive services. In the Netherlands, for instance, sex education is incorporated into the school curriculum, where adolescents receive systematic sexual health education from an early age, while also receiving free contraceptives[ 10][11] . The Planned Parenthood Federation in US and the National Health Service in UK offer free or low-cost contraceptive services and counseling for adolescents, ensuring they have the information and services to make choice. Contraception has high health benefits without the will to have children, and carrying out contraceptive services and education can significantly reduce the pregnancy rate and the burden on society[ 12] . Common contraceptive methods among adolescents include condoms, combined oral contraceptives(COCs), emergency contraceptive pills, and Long-acting Reversible Contraception(LARC). Condoms are widely used among adolescents due to their easy availability and simple use[ 13] . Studies show that increased use of short-acting contraceptives is closely related to the rise in the level of abortions[ 14] . COC holds an significant place in adolescent contraceptive choices because of their easy accessibility, but the compliance of adolescents is relatively poor, which will increase the probability of contraceptive failure and lead to the discontinuation. LARC methods have been proved to be more effective and safer than short-acting contraceptive methods such as pills. LARC options include intrauterine devices (IUDs), which can be categorized into three types: copper-bearing IUD (Cu-IUD); hormonal IUD, which loads drug components on the basis of Cu-IUD; and the levonorgestrel intrauterine system (LNG-IUS), which enhances contraceptive effectiveness by creating a high concentration of progesterone in the uterus. The second method is the subdermal implant, a progestin-only hormone delivery system, serves as an ideal contraceptive option for adolescents who prefer a highly effective, long-lasting method without the need for regular interventions. The third approach is the long-acting contraceptive injections, favored for its ease of use and discreet nature. Despite these advantages, LARC methods are underutilized due to various barriers such as provider knowledge, user acceptance, and cultural barriers[ 15][16] . No contraceptive method is perfect for adolescents, LARC stands out as a more effective alternative when compared to other available options[ 17] . In the array of contraceptive methods, LARC has gained international recognition for their high efficacy, long duration, reversibility, and low maintenance requirements, making them a front-line intervention in adolescent contraception[ 18] . Among LARC, IUD is considered the most cost-effective[ 19] , but LNG-IUS and subdermal implant are also highly regarded for high effectiveness and safety in contraception, offering long-term economic benefits[ 20] . Although the high initial cost of LARC is one of the important barriers influencing adolescents' choice of contraception, it is more cost-effective than methods like the pills in the long run[ 21][22] . Given that adolescents have limited or no income, and are in a stage of physical development, it is essential to provide contraceptive methods with reasonable price and low-risk. Currently, there is a lack of economic evaluations of contraceptive measures based on Chinese population and data, especially high-quality economic research focused on adolescent contraceptive methods. This article compares the costs and effectiveness of IUD, LNG-IUS, subdermal implant, and COC to provide a reference for adolescents in selecting contraceptive measures that can help avoid unintended pregnancies. Methods From a healthcare system perspective, focusing on Chinese female adolescents aged 15-24 with contraceptive needs in 2023. Treeage pro 2022 was used to construct a decision-tree model. The model evaluates four contraceptive strategies costs and effectiveness. The main evaluation metrics include the costs of contraception, the cost-effectiveness of preventing unintended pregnancies, and ICER of each method, which help identify the optimal contraceptive strategy for adolescents (See Figure 1). The contraceptive needs in this model refer to women who were sexually active or partnered, fecund, and did not want a child in the next 5 years. Decision-tree model Decision-tree models are widely used in healthcare economics as they can clarify and visualize complex decision-making problems and processes. It enable decision-makers compare various alternatives briefly and choose the optimal strategy. This study constructs a decision-tree model to evaluate COC、 IUD、 LNG-IUS and subdermal implant by assessing the costs and effectiveness in preventing unintended pregnancies among adolescents (in Appendix A). In 2023, there were approximately 74.4 million female adolescents aged 15-24 in China[ 23] . Taking 15-24-year-old female adolescents with contraceptive needs as sample, comparing the differences in costs and health outcomes of LARC with COC and among LARC methods. The probabilities of contraceptive needs for adolescent are obtained from literature and expert consultation. To eliminate the impact of currency over time, the costs in the model are discounted at an annual interest rate of 5%[ 24] , in accordance with the China Guidelines for Pharmacoeconomic Evaluation 2020 . Costs Only direct costs are used in this model, which include outpatient costs, contraceptive product costs, insertion/removal surgical costs for contraceptive products, and medical expenses related to contraceptive failure leading to abortion or childbirth. The costs of contraceptive products are sourced from the China Medical Information Platform, while medical service prices are derived from healthcare institutions or literature. Considering the different service life of various contraceptive products, the cost parameters are based on a 5-year cycle. In this model, the service life of the IUD exceeds 5 years, and the costs of IUD contraception include: outpatient fees, IUD product costs, and IUD insertion costs. The service life of the LNG-IUS in this model is 5 years, and the costs of LNG-IUS contraception include: outpatient fees, LNG-IUS costs, and LNG-IUS insertion/removal costs. The service life of the subdermal implant is 3 years, and the costs of subdermal implant contraception include: outpatient fees, two subdermal implants costs, two insertions of subdermal implant, and one removal. Due to the higher one-time intake of hormones and more side effects associated with long-acting oral contraceptives, the model focuses on short-acting oral contraceptives. The cost for COC include one box per month over a 5-year period. The costs of insertion and removal of contraceptive devices are sourced from published literature. Costs are expressed in RMB in 2023. For adolescents facing unintended pregnancies, 90% choose to have an abortion[ 25] . Drawing from published research and expert opinions[ 26] , the costs associated with abortion include surgical costs, examination costs, anesthesia costs, and hospital fees. The examination items include B-mode ultrasound examination, complete blood count, blood biochemistry, coagulation monitoring,vaginal discharge examination, gynecological examination,electrocardiogram and infection screening for four items (in Appendix B). It is assumed that the pregnant adolescents opting for a painless (general anesthesia) surgical procedure with a one-day hospital stay. Abortion costs are calculated by averaging medical service prices in Jiangsu, Jiangxi, Shaanxi, and Jilin provinces, with regional categorizations for eastern, central, western, and northeastern regions of China[ 27][28][29][30][31] . The costs of birth for adolescents are sourced from published literature[ 32] . ( See Table 1) Table1 Main parameters and sources Parameters Value Range Source Clinical parameters IUD a contraceptive failure 0.8% 0.7~0.9% WHO LNG-IUS a contraceptive failure 0.7% 0.6~0.8% WHO Subdermal implant contraceptive failure 0.1% 0~0. 2% WHO COC contraceptive failure 7% 0.3~10% WHO Abortion 90% 85~95% [24] Birth 10% 5~15% [24] Costs parameters IUD 230 200~300 Medical institution, expert consultation LNG-IUS 1311.5 1279~1344 China Medical Information Platform Subdermal implant 768.7 China Medical Information Platform COC 14.7 8~75 China Medical Information Platform Medical appointment 30 20~50 Expert consultation IUD insertion/removal 90.5 38~180 [28-31] LNG-IUS insertion/removal 90.5 38~180 [28-31] Subdermal implant insertion/removal 88 45~130 [28-31] Birth 6057.7 4846.16~7269.24 [32] Abortion 1578.65 1262.92~1894.38 [28-31] Abortion operation 186.68 93~320 [28-31] Hospital care 50 Expert consultation Examination 538.78 500~580 [28-31] Other parameters Contraceptive needs 20% 15~25% Expert consultation Discount rate 5% 0~8% [24] IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; COC, combined oral contraception. Health outcomes and Probabilities The model assumes that all female adolescents use LARC and COC methods at the regular frequency and conventional method, that is, in a "typical use" state. The probabilities of contraceptive failure come from the WHO, while the probabilities of adolescents abortion or birth after contraceptive failure are derived from published literature. Cost effectiveness analysis Evaluating and comparing the cost-effectiveness of different contraceptive methods, Cost-effectiveness Ratio(CER) refers to the cost of preventing unintended pregnancies per adolescent female. The model compares the Incremental Cost-Effectiveness Ratio（ICER) between LARC contraceptive methods and COC, as well as among different LARC methods. When comparing LARC methods with COC, the ICER represents the increased cost of avoiding a unit clinical event (such as pregnancy, abortion, and birth). Comparing various LARC methods, the ICER represents the increased cost of avoiding a unit clinical event (such as pregnancy, abortion, and birth), when a LARC method is compared with the lower cost. Sensitivity analysis and validation The model utilizes both one-way and probabilistic sensitivity analyses. The cost parameters encompass the expenses associated with LARC and COC contraceptive strategies, as well as the costs of abortion and childbirth resulting from contraceptive failures. The probabilistic parameters include the likelihood of contraceptive failure with various methods, the chances of opting for abortion or childbirth following contraceptive failure, the probability of contraceptive needs among adolescents, and the discount rate. For the one-way sensitivity analysis, the cost parameters are adjusted by ±20%, the discount rate is modified from 0 to 8%, the contraceptive failure probability for LARC is tweaked by ±0.1%, the contraceptive failure probability for COC is shifted from 0.3 to 10%, and the probabilities of choosing abortion or birth after contraceptive failure, as well as the adolescent contraceptive needs probability, are altered by ±5%. The tornado diagram is utilized to depict the impact of varying a single variable within its maximum or minimum range on the incremental cost-effectiveness ratios. The ICER between COC and various LARC methods are evaluated using one-way sensitivity analysis, with a tornado diagram providing a summary of the model’s uncertainties. The diagram shows how much of that variable influences cost effectiveness. Probabilistic sensitivity analysis is conducted using a Monte Carlo simulation (N=1000) to assess the effects of multiple parameters changing concurrently. The model posits that cost parameters adhere to a Gamma distribution, while probability parameters conform to a Beta distribution. The outcomes of the analysis are depicted through cost-effectiveness acceptability curves and scatter plots. In this model, per capita GDP is used as a threshold to assess the economic viability of a strategy. In 2023, China's per capita GDP was RMB 89,538[[ 33 ]]. A strategy is considered highly cost-effectiveness when the ICER <1 per capita GDP; it is considered cost-effectiveness when the 1 per capita GDP < ICER 3 per capita GDP. The acceptability curve illustrates that the probability of a contraceptive method will be economically acceptable provided a cost-effectiveness threshold is defined. The probability of the contraceptive method being cost effective is plotted on the y-axis, with a wide variety of potential cost-effectiveness thresholds distributed along the x-axis. The scatter plot illustrates the relationship between incremental costs and incremental effects, showcasing the central tendency and distribution of various parameters. Results Basic analysis To prevent unintended pregnancies for 14.88 million adolescent females, the contraceptive costs required for IUD, LNG-IUS, subdermal implant, and COC are RMB 54.57, 236.99, 292.14, and 166.15 billion respectively, which can prevent 14.76 million, 14.78 million, 14.87 million, and 13.84 million unintended pregnancies among adolescents. To prevent a single case of unintended pregnancy in adolescents, the costs for IUD, LNG-IUS, subdermal implant, and COC are RMB 369.67, 1603.88, 1965.30, and 1200.62, respectively, IUD shows the best cost-effectiveness.(see Table 2) Table 2 Cost, effectiveness and cost-effectiveness of various contraceptive methods Contraception strategy Avoid pregnancy Cost (RMB) Cost/Effectiveness IUD a 14760960 5456681100.00 369.67 LNG-IUS 14775840 23698719600.00 1603.88 IMPLANT 14865120 29214447900.00 1965.30 COC 13838400 16614693288.00 1200.62 IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; COC, combined oral contraception; Comparing various long-acting reversible contraception (LARC) methods with COC, the IUD demonstrates significant contraceptive advantages. It manages to prevent unintended pregnancies in adolescents at a lower cost, leading to fewer abortions and births. Compared to COC, the IUD has an ICER of -12094.62, -13438.53, and -120888.54 for each averted adolescent pregnancy, abortion, and birth, respectively, indicating high economic value (less than one times the per capita GDP). The LNG-IUS and subdermal implant also show economic benefits (less than three times the per capita GDP). To prevent a single unintended pregnancy in adolescents, an additional investment of RMB7556.78 and RMB 12271.85 is required for the LNG-IUS and subdermal implant compared to COC, both of which are below the GDP per head of China. (see Table 3) Table 3 Clinical and cost difference of LARC a methods compared with COC and their ICER a Outcomes Clinical difference Cost difference ICER Avoided pregnancy IUD versus COC 922560 -11158012188.00 -12094.62 LNG-IUS a versus COC 937440 7084026312.00 7556.78 Subdermal implant versus COC 1026720 12599754612.00 12271.85 Avoided abortion IUD versus COC 830300 -11158012188.00 -13438.53 LNG-IUS versus COC 843700 7084026312.00 8396.38 Subdermal implant versus COC 924000 12599754612.00 13636.10 Avoided birth IUD versus COC 92300 -11158012188.00 -120888.54 LNG-IUS versus COC 93800 7084026312.00 75522.67 Subdermal implant versus COC 102700 12599754612.00 122685.05 Note: In ICER, the negative signs mean that it is cost saving. LARC, long-acting reversible contraceptive; COC, combined oral contraception; ICER, incremental cost-effectiveness rate; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system. Comparing different LARC methods (in Appendix C), although LNG-IUS and subdermal implants can prevent more unintended pregnancies, abortions, and births among adolescents, their costs are higher. Compared with IUD, the ICER for LNG-IUS is not cost-effective (>3 per capita GDP), while the ICER for subdermal implants is RMB 228089.16, which has a certain cost-effectiveness (<3 per capita GDP). However, compared with LNG-IUS, the ICER for subdermal implants is RMB 61780.11, which is very cost-effective (<1 per capita GDP). Sensitivity analysis One-way sensitivity analysis Comparing COC with IUD or LNG-IUS, the cost of contraception with COC, IUD or LNG-IUS is the main factor affecting the baseline results. When comparing COC with subdermal implants, the main factor affecting the baseline results is the probability of contraceptive failure with COC. The tornado diagrams for each outcome are illustrated in Appendix D. Probabilistic sensitivity analyses Comparing COC with various LARC methods, under the threshold of 1 times per capita GDP, each LARC contraceptive method is more cost-effectiveness, and the most of the scatter points fall below the threshold line, which indicates robust results. Comparing different LARC methods, under the threshold of 1 times per capita GDP, IUD is more cost-effectiveness, and the most of the scatter points fall below the threshold line, which indicates robust results. The scatterplot for each outcome are illustrated in Appendix D. The acceptability curve results show that under the threshold of 3 times per capita GDP, IUD is always cost-effectiveness. When WTP=RMB18765.18, the likelihood of IUD being the optimal strategy is close to 100%. However, when WTP exceeds RMB 20000, the likelihood of IUD being the optimal strategy decreases, and the likelihood of LNG-IUS and subdermal implant being the optimal strategy continues to increase. When WTP is 3 times the per capita GDP, the likelihood of IUD, subdermal implant, and LNG-IUS being the optimal strategy is 52.7%, 31.2%, and 16.1% respectively (see Figure 2). Discussion This study provides a comprehensive evaluation of contraceptive strategies for Chinese adolescents, offering insights into cost-effective options to help reduce unintended pregnancies and improve health outcomes. Based on the perspective of health system, a decision-tree model was developed to assess the cost-effectiveness of COC and LARC contraceptive methods for adolescents. This analysis aims to promote the adoption of more economical and effective contraceptive methods among adolescents to prevent unintended pregnancy. The results indicates that within five years, compared with COC, IUD can prevent more unintended pregnancies, abortions and births at a lower cost among adolescents. Similarly, LNG-IUS and subdermal implant also demonstrate strong cost-effectiveness. This is consistent with the research in the United States[ 34] , Brazil [19] and Britain [22] . Among the four contraceptive methods, subdermal implant offers the highest contraceptive effectiveness, IUD has the lowest contraceptive cost. IUD is dominant in terms of cost-effectiveness among the four contraceptive strategies. COC, as one of the typical contraceptive methods for teenagers, IUD, LNG-IUS and subdermal implant are more cost-effectiveness over five-year use conditions in this model. Although LNG-IUS and subdermal implant can prevent more adolescents from getting pregnant, they come at a higher cost. Overall, LARC is a contraceptive measure that is more suitable for long-term contraception in adolescents. In one-way sensitivity analysis, the probability of subdermal implant contraceptive failure is consistently lower than the COC’s, making the probability of COC contraceptive failure is the main factor affecting baseline results. The higher the probability, the greater the impact on outcomes. In probability sensitivity analysis, when WTP<RMB 20000, COC may be the preferred option compared to the LNG-IUS and subdermal implants. Recent years, Chinese adolescents have become more open in their attitudes towards sexual behavior, with trends showing younger ages of sexual initiation. However, due to inconvenient access to contraceptives, previous uncomfortable sexual experiences, and a sense of invulnerability, it is easy for adolescents to get pregnant unexpectedly[ 35] . At the same time, adolescents lack knowledge and education about sexual and reproductive health[ 36] , which makes the proportion of repeated abortions among teenagers increase. Faced with the high incidence of unintended pregnancy and the increasing demand for contraception in China, it is crucial to encourage adolescents to adopt LARC method, especially IUD, which can not only meet the needs of adolescents, reduce the incidence of unintended pregnancy and save costs, but also offer significant long-term health benefits, supporting adolescents' future development and contributing to social progress. Limitations This study has certain limitations. Firstly, it does not account for the issue of repeat pregnancies, a constraint imposed by the lack of available data. Secondly, the model overlooks the cost of adverse reactions associated with different contraceptive methods and the long-term economic and social value derived from preventing unintended pregnancies among teenagers. The former issue may lead to an underestimation of the contraceptive costs for teenagers, while the latter may result in an underestimation of the contraceptive effectiveness for this age group. However, overall, the benefits of preventing unintended pregnancies in teenagers are likely to be higher. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding No fund. Authors’ contributions WL participated in the design of the study, performed the data analyses and drafted the initial manuscript; DW was responsible for data handling and supported the data analysis; GX participated in the design of the study and reviewed and revised the manuscript; LZ. participated in the design of the analysis and participated in the drafting of the manuscript and reviewed and revised the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Sully EA, Biddlecom A, Daroch J, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019[Internet]. New York: Guttmacher Institute; 2020[cited 2024 Sep 17]. Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019. Haakenstad A, Angelino O, Irvine CMS, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022 Jul 23;400(10348):295-327. DOI: 10.1016/S0140-6736(22)00936-9. Sedgh, G., Finer, L. B., et al. Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health, 56(2), 223-230. DOI: 10.1016/j.jadohealth.2014.09.007. WHO[Internet]. Adolescent pregnancy; c2020[cited 2024 Sep 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy. United Nations Population Fund[Internet]. Motherhood in childhood: Facing the challenge of adolescent pregnancy; c2013[cited 2024 Sep 17]. Available from: https://unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013.pdf Zheng XY, Cheng G. Survey of Youth Access to Reproductive Health in China. Population and Development. 2010 May 29;16(3):2-16. (in Chinese). Zhao R, Zhang R, Fu XX, et al. Sexual and reproductive health related knowledge, attitude and behavior among senior high school and college students in 11 provinces and municipalities of China. Chinese Journal of Public Health. 2019 Aug 6;35(10):1330-1338. (in Chinese). Chinese Society of Family Planning of Chinese Medical Association, National Research Institute for Family Planning. Guidelines for adolescent contraceptive services. Chinese Journal of Obstetrics and Gynecology. 2020 Feb 5;55(2):83-90. DOI:10.3760/cma.j.issn.0529-567X.2020.02.005. (in Chinese). Liu XM. Ensure the reproductive health of adolescents is not compromised. Journal of the Chinese People's Political Consultative Conference. 2022 Feb 23;02-23(005). DOI:10.28660/n.cnki.nrmzx.2022.001041. (in Chinese). Lu MQ, Liu WL. International experience and enlightenment on the development of comprehensive sex education. New Curriculum Review. 2018 Aug 15;(Z1):176-185. (in Chinese). van der Doef S, Reinders J. Stepwise sexual development of adolescents: the Dutch approach to sexuality education. Nat Rev Urol. 2018 Mar;15(3):133-134. DOI: 10.1038/nrurol.2018.3. Goldfarb ES, Lieberman LD. Three Decades of Research: The Case for Comprehensive Sex Education. J Adolesc Health. 2021 Jan;68(1):13-27. DOI: 10.1016/j.jadohealth.2020.07.036. Epub 2020 Oct 12. Zhang YS, Zhang XX. Li XY, et al. (2020). Chinese Journal of Family Planning & Gynecotokology. 2020 Apr 25;12(04):4-6. (in Chinese). Gu XY, Che Y. Insight of the big data about artificial abortion and contraception in family planning work after the birth control policy was eased in China. Chinese Journal of Practical Gynecology and Obstetrics. 2018 Jau 2;34(1):46-51. (in Chinese). Coles CB, Shubkin CD. Effective, recommended, underutilized: a review of the literature on barriers to adolescent usage of long-acting reversible contraceptive methods. Curr Opin Pediatr. 2018 Oct;30(5):683-688. DOI: 10.1097/MOP.0000000000000663. Zhuang WM, Ji F, Li HJ, Zhang KH. Awareness and usage of long-acting reversible contraception in adolescents. Chinese Preventive Medicine. 2022 Aug 31;23(12):949-955. DOI:10.16506/j.1009-6639.2022.12.011. (in Chinese). Steyn PS, Goldstuck ND. Contraceptive needs of the adolescent. Best Pract Res Clin Obstet Gynaecol. 2014 Aug;28(6):891-901. DOI: 10.1016/j.bpobgyn.2014.04.012. Rosenthal MA, McQuillan SK. Adolescent contraception. CMAJ. 2021 Aug 9;193(31):E1218. DOI: 10.1503/cmaj.202413. Farah D, de Moraes Andrade TR, Sansone D, et al. A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System. Am J Prev Med. 2022 Jan;62(1):114-121. DOI: 10.1016/j.amepre.2021.06.023 Kim CS, Lunde B, MacIsaac L, et al. Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis. Contraception. 2021 Feb;103(2):107-112. DOI: 10.1016/j.contraception.2020.11.009. Eisenberg D, McNicholas C, Peipert JF. Cost as a barrier to long-acting reversible contraceptive (LARC) use in adolescents. J Adolesc Health. 2013 Apr;52(4 Suppl):S59-63. DOI: 10.1016/j.jadohealth.2013.01.012. Mavranezouli I; LARC Guideline Development Group. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod. 2008 Jun;23(6):1338-45. DOI: 10.1093/humrep/den091. WHO[Internet]. Health data overview for the People’s Republic of China. c2024[cited 2024 Sep 17]. Available from: https://data.who.int/countries/156. Chinese Pharmaceutical Association[Internet]. China Guidelines for Pharmacoeconomic Evaluations(2020). c2020[cited 2024 Sep 17]. Available from: https://www.cpa.org.cn/cpadmn/attached/file/20201203/1606977380634185.pdf. UNFPA China[Internet]. Ending Unintended Pregnancies among Chinese Youth by 2030. c2018[cited 2024 Sep 17]. Available from: https://china.unfpa.org/sites/default/files/pub-pdf/Ending%20Unintended%20Pregnancies%20among%20Chinese%20Unmarried%20Youth%20by%202030-Final.pdf Zhao XR, Gao JL, Liu CP, et al. Health Economics Evaluation of Post-abortion Care and Routine Care Service after Abortion for Patients with Unwanted Pregnancy. Chinese Health Economics. 2022 Jul 5;41(07):71-76. (in Chinese). National Bureau of Statistics[Internet]. How to divide the East, Central, and Western Economic Belt, and how to include the three provinces of Northeast China in the East, Central, and Western Regions?. c2021[cited 2024 Sep 17]. Available from: https://www.stats.gov.cn/hd/lyzx/zxgk/202107/t20210730_1820095.html. Jiangsu Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jiangsu Province (2023). c2024. [cited 2024 Sep 17]. Available from: https://ybj.jiangsu.gov.cn/module/download/downfile.jsp?classid=0&filename=32fe93ac99f04b7da06b 141 905596b.pdf. Jiangxi Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jiangxi Province(2023). c2023. [cited 2024 Sep 17]. Available from: https://www.jiangxi.gov.cn/art/2023/12/4/art_65599_4743365.html. Shanxi Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Shanxi Province (2024). c2024. [cited 2024 Sep 17]. Available from: http://ybj.shaanxi.gov.cn/zwgk/sjfb/ylby/33516.htm. Jilin Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jilin Province (2023). C2023[cited 2024 Sep 17]. Available from: https://xxgk.jl.gov.cn/zsjg/fgw/xxgkmlqy/202312/t20231227_8857684.html. National Health Commission of the People’s Republic of China[Internet]. 2022 China Health Statistics Yearbook. c2023[cited 2024 Sep 17]. Available from: http://www.nhc.gov.cn/mohwsbwstjxxzx/tjtjnj/202305/6ef68aac6bd14c1eb9375e01a0faa1fb/files/b05b3d958fc546d98261d165ce 4 dba.pdf. National Bureau of Statistics[Internet]. Statistical Bulletin on National Economic and Social Development of the People's Republic of China in 2023. C2024[cited 2024 Sep 17]. Available from: https://www.stats.gov.cn/sj/zxfb/202402/t20240228_1947915.html. Trussell J, Hassan F, Lowin J, et al. Achieving cost-neutrality with long-acting reversible contraceptive methods. Contraception. 2015 Jan;91(1):49-56. DOI: 10.1016/j.contraception.2014.08.011. Zhang N, Zhang SN, Tian ST, et al. The current contraceptice situation and the contraceptive guidance for the adolescents client of induced abortion. Chinese Journal of Family Planning. 2024 Feb 15;32(02):460-463. (in Chinese). Nie Y, Zheng RM, Luo XM, Xu YW. (2022). Investigation and analysis of sexual development situation and knowledge, attitude and behavior about sexual and reproductive health of 15415 adolescents in China. Chinese Journal of Woman and Child Health Research. 2022 Apr 25;33(04):68-74. (in Chinese). Additional Declarations No competing interests reported. Supplementary Files appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5393510","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":378362801,"identity":"9c9b209d-21c3-47f8-b020-6753f8dcd84e","order_by":0,"name":"Weihua Luo","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Weihua","middleName":"","lastName":"Luo","suffix":""},{"id":378362802,"identity":"738cb616-d6ae-4af4-850a-6d28d4c8d9f1","order_by":1,"name":"Di Wang","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Di","middleName":"","lastName":"Wang","suffix":""},{"id":378362803,"identity":"b6dba609-364d-4dd4-a0cb-8799b0dd499c","order_by":2,"name":"Gan Xu","email":"","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Gan","middleName":"","lastName":"Xu","suffix":""},{"id":378362804,"identity":"625928dc-59e3-48b7-9eee-a8c168c6cde8","order_by":3,"name":"Liangru Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIie3PoQ7CMBDG8Wua3ExBV1EeYQS7hylmM8NPkiwphqBR8Bboa5qgxhNglvACJJgZCJtEEA6H6F/fL/kOIBb7xxIAulV6gklNTCJB+F2TzcfqZNlEhpHLF3tdTnnC1KOWFIbCQQnQVcfvRNRJSlqFpYMziU1zYeySCJTqnoitlcIxCA7EpqFAqVIeUQMhm1tELtE98SvKZk6h9axfzNrJ++OpjTlcfdtVDPIW/Xgfi8VisU+9AEtdN4EV9GnzAAAAAElFTkSuQmCC","orcid":"","institution":"Beijing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Liangru","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-11-05 08:23:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5393510/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5393510/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69339324,"identity":"68d51cb8-4b47-4a12-a9d7-e01fc44b827d","added_by":"auto","created_at":"2024-11-19 10:42:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":277788,"visible":true,"origin":"","legend":"\u003cp\u003eDecision Model for Different Contraceptive Methods\u003c/p\u003e\n\u003cp\u003eLARC, long-acting reversible contraceptive; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; COC, combined oral contraception; ICER, incremental cost-effectiveness rate.\u003c/p\u003e","description":"","filename":"Figure1Decisionmodelfordifferentcontraceptivemethods.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5393510/v1/5e57f2e5d683e5f33714ef8a.jpg"},{"id":69339325,"identity":"0626d93b-1170-4815-857c-74db53b2e0e4","added_by":"auto","created_at":"2024-11-19 10:42:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":237144,"visible":true,"origin":"","legend":"\u003cp\u003eAcceptability curve of COC and LARC methods simulated by model Monte Carlo\u003c/p\u003e\n\u003cp\u003eCOC, combined oral contraception; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system.\u003c/p\u003e","description":"","filename":"Figure2AcceptabilitycurveofCOCandLARCmethods.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5393510/v1/40e4df9db0499bb336ad7f73.jpg"},{"id":74977505,"identity":"cc5c7ff9-cece-4bcb-a494-1126446cd336","added_by":"auto","created_at":"2025-01-29 03:38:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1115698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5393510/v1/dea2cba5-a095-4c38-bbaa-19c5c18f7b6d.pdf"},{"id":69339326,"identity":"723c29a1-7e2e-4028-bdf8-02c8dcdbe42c","added_by":"auto","created_at":"2024-11-19 10:42:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1374465,"visible":true,"origin":"","legend":"","description":"","filename":"appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-5393510/v1/40a6c23ffd905a4002be3fd6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cost-effectiveness of different contraceptive methods to avoid unintended pregnancy among adolescents in China: A modeling analysis based on decision-tree modle","fulltext":[{"header":"Background","content":"\u003cp\u003eThe problem of unintended pregnancy among adolescents spreads worldwide. It is estimated 21 million girls aged 15-19 pregnant annually in developing countries, and nearly 12 million of them give birth[\u003csup\u003e1]\u003c/sup\u003e. Compared with women aged 25-49, adolescents (15-24 years) account for 26.5% of the global unmet need for contraception, leading to a significant number of unintended pregnancies due to the lack of or incorrect use of contraceptive methods[\u003csup\u003e2]\u003c/sup\u003e. With the initial sexual activity among adolescents occurred at younger ages, and the physical and mental health caused by unexpected pregnancies affects their future development seriously[\u003csup\u003e3]\u003c/sup\u003e. Young women also face a series of challenges such as educational disruption, social discrimination, career retardation, and challenges to economic independence[\u003csup\u003e4][5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn China, 51.2% of adolescents aged 15-24 have their first sexual behavior without using any contraceptive measures, resulting in a pregnancy rate of 3%, which increases at a rate of 6.9% per year[\u003csup\u003e6]\u003c/sup\u003e. In the past 20 years, the age of first sexual experience among Chinese adolescents has been advanced[\u003csup\u003e7]\u003c/sup\u003e, while the age of marriage and childbearing has been postponed, which means that unintended pregnancy often ends in induced abortion among adolescents[\u003csup\u003e8]\u003c/sup\u003e. Studies show that the proportion of young, unmarried, and childless women induced abortion is continuously increasing, with a significant increase in high-risk and repeated abortions among those under 20, also, unmarried adolescents under the age of 24 account for more than 40% of the total number of abortions in China every year, with nearly 20% having experienced repeated abortions[\u003csup\u003e9]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAdolescence is a critical period for sexual health education and contraceptive intervention. Many countries have implemented various measures to popularize contraceptive knowledge and provide contraceptive services. In the Netherlands, for instance, sex education is incorporated into the school curriculum, where adolescents receive systematic sexual health education from an early age, while also receiving free contraceptives[\u003csup\u003e10][11]\u003c/sup\u003e. The Planned Parenthood Federation in US and the National Health Service in UK offer free or low-cost contraceptive services and counseling for adolescents, ensuring they have the information and services to make choice. Contraception has high health benefits without the will to have children, and carrying out contraceptive services and education can significantly reduce the pregnancy rate and the burden on society[\u003csup\u003e12]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCommon contraceptive methods among adolescents include condoms, combined oral contraceptives(COCs), emergency contraceptive pills, and Long-acting Reversible Contraception(LARC). Condoms are widely used among adolescents due to their easy availability and simple use[\u003csup\u003e13]\u003c/sup\u003e. Studies show that increased use of short-acting contraceptives is closely related to the rise in the level of abortions[\u003csup\u003e14]\u003c/sup\u003e. COC holds an significant place in adolescent contraceptive choices because of their easy accessibility, but the compliance of adolescents is relatively poor, which will increase the probability of contraceptive failure and lead to the discontinuation. LARC methods have been proved to be more effective and safer than short-acting contraceptive methods such as pills. LARC options include intrauterine devices (IUDs), which can be categorized into three types: copper-bearing IUD (Cu-IUD); hormonal IUD, which loads drug components on the basis of Cu-IUD; and the levonorgestrel intrauterine system (LNG-IUS), which enhances contraceptive effectiveness by creating a high concentration of progesterone in the uterus. The second method is the subdermal implant, a progestin-only hormone delivery system, serves as an ideal contraceptive option for adolescents who prefer a highly effective, long-lasting method without the need for regular interventions. The third approach is the long-acting contraceptive injections, favored for its ease of use and discreet nature. Despite these advantages, LARC methods are underutilized due to various barriers such as provider knowledge, user acceptance, and cultural barriers[\u003csup\u003e15][16]\u003c/sup\u003e. No contraceptive method is perfect for adolescents, LARC stands out as a more effective alternative when compared to other available options[\u003csup\u003e17]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn the array of contraceptive methods, LARC has gained international recognition for their high efficacy, long duration, reversibility, and low maintenance requirements, making them a front-line intervention in adolescent contraception[\u003csup\u003e18]\u003c/sup\u003e. Among LARC, IUD is considered the most cost-effective[\u003csup\u003e19]\u003c/sup\u003e, but LNG-IUS and subdermal implant are also highly regarded for high effectiveness and safety in contraception, offering long-term economic benefits[\u003csup\u003e20]\u003c/sup\u003e. Although the high initial cost of LARC is one of the important barriers influencing adolescents\u0026apos; choice of contraception, it is more cost-effective than methods like the pills in the long run[\u003csup\u003e21][22]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eGiven that adolescents have limited or no income, and are in a stage of physical development, it is essential to provide contraceptive methods with reasonable price and low-risk. Currently, there is a lack of economic evaluations of contraceptive measures based on Chinese population and data, especially high-quality economic research focused on adolescent contraceptive methods. This article compares the costs and effectiveness of IUD, LNG-IUS, subdermal implant, and COC to provide a reference for adolescents in selecting contraceptive measures that can help avoid unintended pregnancies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFrom a healthcare system perspective, focusing on Chinese female adolescents aged 15-24 with contraceptive needs in 2023. Treeage pro 2022 was used to construct a decision-tree model. The model evaluates four contraceptive strategies costs and effectiveness. The main evaluation metrics include the costs of contraception, the cost-effectiveness of preventing unintended pregnancies, and ICER of each method, which help identify the optimal contraceptive strategy for adolescents (See Figure 1). The contraceptive needs in this model refer to women who were sexually active or partnered, fecund, and did not want a child in the next 5 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDecision-tree model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDecision-tree models are widely used in healthcare economics as they can clarify and visualize complex decision-making problems and processes. It enable decision-makers compare various alternatives briefly and choose the optimal strategy. This study constructs a decision-tree model to evaluate COC、\u0026nbsp;IUD、\u0026nbsp;LNG-IUS and subdermal implant by assessing the costs and effectiveness in preventing unintended pregnancies among adolescents (in Appendix A).\u003c/p\u003e\n\u003cp\u003eIn 2023, there were approximately 74.4 million female adolescents aged 15-24 in China[\u003csup\u003e23]\u003c/sup\u003e. Taking 15-24-year-old female adolescents with contraceptive needs as sample, comparing the differences in costs and health outcomes of LARC with COC and among LARC methods. The probabilities of contraceptive needs for adolescent are obtained from literature and expert consultation. To eliminate the impact of currency over time, the costs in the model are discounted at an annual interest rate of 5%[\u003csup\u003e24]\u003c/sup\u003e, in accordance with the \u003cem\u003eChina Guidelines for Pharmacoeconomic Evaluation 2020\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCosts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly direct costs are used in this model, which include outpatient costs, contraceptive product costs, insertion/removal surgical costs for contraceptive products, and medical expenses related to contraceptive failure leading to abortion or childbirth. The costs of contraceptive products are sourced from the China Medical Information Platform, while medical service prices are derived from healthcare institutions or literature.\u003c/p\u003e\n\u003cp\u003eConsidering the different service life of various contraceptive products, the cost parameters are based on a 5-year cycle. In this model, the service life of the IUD exceeds 5 years, and the costs of IUD contraception include: outpatient fees, IUD product costs, and IUD insertion costs. The service life of the LNG-IUS in this model is 5 years, and the costs of LNG-IUS contraception include: outpatient fees, LNG-IUS costs, and LNG-IUS insertion/removal costs. The service life of the subdermal implant is 3 years, and the costs of subdermal implant contraception include: outpatient fees, two subdermal implants costs, two insertions of subdermal implant, and one removal. Due to the higher one-time intake of hormones and more side effects associated with long-acting oral contraceptives, the model focuses on short-acting oral contraceptives. The cost for COC include one box per month over a 5-year period. The costs of insertion and removal of contraceptive devices are sourced from published literature. Costs are expressed in RMB in 2023.\u003c/p\u003e\n\u003cp\u003eFor adolescents facing unintended pregnancies, 90% choose to have an abortion[\u003csup\u003e25]\u003c/sup\u003e. Drawing from published research and expert opinions[\u003csup\u003e26]\u003c/sup\u003e, the costs associated with abortion include surgical costs, examination costs, anesthesia costs, and hospital fees. The examination items include B-mode ultrasound examination, complete blood count, blood biochemistry, coagulation monitoring,vaginal discharge examination, gynecological examination,electrocardiogram and infection screening for four items (in Appendix B). It is assumed that the pregnant adolescents opting for a painless (general anesthesia) surgical procedure with a one-day hospital stay. Abortion costs are calculated by averaging medical service prices in Jiangsu, Jiangxi, Shaanxi, and Jilin provinces, with regional categorizations for eastern, central, western, and northeastern regions of China[\u003csup\u003e27][28][29][30][31]\u003c/sup\u003e. The costs of birth for adolescents are sourced from published literature[\u003csup\u003e32]\u003c/sup\u003e. ( See Table 1)\u003c/p\u003e\n\u003cp\u003eTable1 Main parameters and sources\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eParameters\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003eValue\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003eRange\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eSource\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eClinical parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eIUD\u003csup\u003ea\u003c/sup\u003e contraceptive failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e0.7~0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eLNG-IUS\u003csup\u003ea\u003c/sup\u003e contraceptive failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e0.6~0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eSubdermal implant contraceptive failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e0.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e0~0. 2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eCOC contraceptive failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e0.3~10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eAbortion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e85~95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[24]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eBirth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e5~15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[24]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eCosts parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eIUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e200~300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eMedical institution, expert consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eLNG-IUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e1311.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e1279~1344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eChina Medical Information Platform\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eSubdermal implant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e768.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eChina Medical Information Platform\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eCOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e8~75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eChina Medical Information Platform\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eMedical appointment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e20~50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eExpert consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eIUD insertion/removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e38~180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eLNG-IUS insertion/removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e38~180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eSubdermal implant insertion/removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e45~130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eBirth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e6057.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e4846.16~7269.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[32]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eAbortion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e1578.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e1262.92~1894.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eAbortion operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e186.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e93~320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eHospital care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eExpert consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eExamination\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e538.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e500~580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[28-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eOther parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eContraceptive needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e15~25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003eExpert consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2404%;\"\u003e\n \u003cp\u003eDiscount rate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3005%;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1293%;\"\u003e\n \u003cp\u003e0~8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3297%;\"\u003e\n \u003cp\u003e[24]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIUD,\u0026nbsp;intrauterine device; LNG-IUS,\u0026nbsp;levonorgestrel intrauterine system; COC,\u0026nbsp;combined oral contraception.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth outcomes and Probabilities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe model assumes that all female adolescents use LARC and COC methods at the regular frequency and conventional method, that is, in a \u0026quot;typical use\u0026quot; state. The probabilities of contraceptive failure come from the WHO, while the probabilities of adolescents abortion or birth after contraceptive failure are derived from published literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCost effectiveness analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvaluating and comparing the cost-effectiveness of different contraceptive methods, Cost-effectiveness Ratio(CER) refers to the cost of preventing unintended pregnancies per adolescent female. The model compares the Incremental Cost-Effectiveness Ratio（ICER) between LARC contraceptive methods and COC, as well as among different LARC methods. When comparing LARC methods with COC, the ICER represents the increased cost of avoiding a unit clinical event (such as pregnancy, abortion, and birth). Comparing various LARC methods, the ICER represents the increased cost of avoiding a unit clinical event (such as pregnancy, abortion, and birth), when a LARC method is compared with the lower cost.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity analysis and validation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe model utilizes both one-way and probabilistic sensitivity analyses. The cost parameters encompass the expenses associated with LARC and COC contraceptive strategies, as well as the costs of abortion and childbirth resulting from contraceptive failures. The probabilistic parameters include the likelihood of contraceptive failure with various methods, the chances of opting for abortion or childbirth following contraceptive failure, the probability of contraceptive needs among adolescents, and the discount rate.\u003c/p\u003e\n\u003cp\u003eFor the one-way sensitivity analysis, the cost parameters are adjusted by \u0026plusmn;20%, the discount rate is modified from 0 to 8%, the contraceptive failure probability for LARC is tweaked by \u0026plusmn;0.1%, the contraceptive failure probability for COC is shifted from 0.3 to 10%, and the probabilities of choosing abortion or birth after contraceptive failure, as well as the adolescent contraceptive needs probability, are altered by \u0026plusmn;5%. The tornado diagram is utilized to depict the impact of varying a single variable within its maximum or minimum range on the incremental cost-effectiveness ratios. The ICER between COC and various LARC methods are evaluated using one-way sensitivity analysis, with a tornado diagram providing a summary of the model\u0026rsquo;s uncertainties. The diagram shows how much of that variable influences cost effectiveness.\u003c/p\u003e\n\u003cp\u003eProbabilistic sensitivity analysis is conducted using a Monte Carlo simulation (N=1000) to assess the effects of multiple parameters changing concurrently. The model posits that cost parameters adhere to a Gamma distribution, while probability parameters conform to a Beta distribution. The outcomes of the analysis are depicted through cost-effectiveness acceptability curves and scatter plots. In this model, per capita GDP is used as a threshold to assess the economic viability of a strategy. In 2023, China\u0026apos;s per capita GDP was RMB 89,538[[\u003csup\u003e33\u003c/sup\u003e]]. A strategy is considered highly cost-effectiveness when the ICER \u0026lt;1 per capita GDP; it is considered cost-effectiveness when the 1 per capita GDP \u0026lt; ICER \u0026lt;3 per capita GDP; and it is deemed not cost-effective when the ICER \u0026gt;3 per capita GDP. The acceptability curve illustrates that the probability of a contraceptive method will be economically acceptable provided a cost-effectiveness threshold is defined. The probability of the contraceptive method being cost effective is plotted on the y-axis, with a wide variety of potential cost-effectiveness thresholds distributed along the x-axis. The scatter plot illustrates the relationship between incremental costs and incremental effects, showcasing the central tendency and distribution of various parameters.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBasic analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo prevent unintended pregnancies for 14.88 million adolescent females, the contraceptive costs required for IUD, LNG-IUS, subdermal implant, and COC are RMB 54.57, 236.99, 292.14, and 166.15 billion respectively, which can prevent 14.76 million, 14.78 million, 14.87 million, and 13.84 million unintended pregnancies among adolescents. To prevent a single case of unintended pregnancy in adolescents, the costs for IUD, LNG-IUS, subdermal implant, and COC are RMB 369.67, 1603.88, 1965.30, and 1200.62, respectively, IUD shows the best cost-effectiveness.(see Table 2)\u003c/p\u003e\n\u003cp\u003eTable 2 Cost, effectiveness and cost-effectiveness of various contraceptive methods\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.2153%;\"\u003e\n \u003cp\u003eContraception strategy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9167%;\"\u003e\n \u003cp\u003eAvoid pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.3472%;\"\u003e\n \u003cp\u003eCost (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.5208%;\"\u003e\n \u003cp\u003eCost/Effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.2153%;\"\u003e\n \u003cp\u003eIUD\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9167%;\"\u003e\n \u003cp\u003e14760960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.3472%;\"\u003e\n \u003cp\u003e5456681100.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.5208%;\"\u003e\n \u003cp\u003e369.67\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.2153%;\"\u003e\n \u003cp\u003eLNG-IUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9167%;\"\u003e\n \u003cp\u003e14775840\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.3472%;\"\u003e\n \u003cp\u003e23698719600.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.5208%;\"\u003e\n \u003cp\u003e1603.88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.2153%;\"\u003e\n \u003cp\u003eIMPLANT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9167%;\"\u003e\n \u003cp\u003e14865120\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.3472%;\"\u003e\n \u003cp\u003e29214447900.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.5208%;\"\u003e\n \u003cp\u003e1965.30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.2153%;\"\u003e\n \u003cp\u003eCOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.9167%;\"\u003e\n \u003cp\u003e13838400\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.3472%;\"\u003e\n \u003cp\u003e16614693288.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.5208%;\"\u003e\n \u003cp\u003e1200.62\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system; COC, combined oral contraception;\u003c/p\u003e\n\u003cp\u003eComparing various long-acting reversible contraception (LARC) methods with COC, the IUD demonstrates significant contraceptive advantages. It manages to prevent unintended pregnancies in adolescents at a lower cost, leading to fewer abortions and births. Compared to COC, the IUD has an ICER of -12094.62, -13438.53, and -120888.54 for each averted adolescent pregnancy, abortion, and birth, respectively, indicating high economic value (less than one times the per capita GDP). The LNG-IUS and subdermal implant also show economic benefits (less than three times the per capita GDP). To prevent a single unintended pregnancy in adolescents, an additional investment of RMB7556.78 and RMB 12271.85 is required for the LNG-IUS and subdermal implant compared to COC, both of which are below the GDP per head of China. (see Table 3)\u003c/p\u003e\n\u003cp\u003eTable 3 Clinical and cost difference of LARC\u003csup\u003ea\u003c/sup\u003e methods compared with COC and their ICER\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eOutcomes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003eClinical difference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003eCost difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eICER\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eAvoided pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eIUD\u003csup\u003e\u0026nbsp;\u003c/sup\u003eversus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e922560\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e-11158012188.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e-12094.62\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eLNG-IUS\u003csup\u003ea\u003c/sup\u003e versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e937440\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e7084026312.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e7556.78\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eSubdermal implant versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e1026720\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e12599754612.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e12271.85\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eAvoided abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003e\u0026nbsp;IUD versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e830300\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e-11158012188.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e-13438.53\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eLNG-IUS versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e843700\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e7084026312.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e8396.38\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eSubdermal implant versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e924000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e12599754612.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e13636.10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eAvoided birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003e\u0026nbsp;IUD versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e92300\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e-11158012188.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e-120888.54\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eLNG-IUS versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e93800\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e7084026312.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e75522.67\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.4775%;\"\u003e\n \u003cp\u003eSubdermal implant versus COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3604%;\"\u003e\n \u003cp\u003e102700\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.1622%;\"\u003e\n \u003cp\u003e12599754612.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e122685.05\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: In ICER, the negative signs mean that it is cost saving.\u003c/p\u003e\n\u003cp\u003eLARC, long-acting reversible contraceptive; COC, combined oral contraception; ICER, incremental cost-effectiveness rate; IUD, intrauterine device; LNG-IUS, levonorgestrel intrauterine system.\u003c/p\u003e\n\u003cp\u003eComparing different LARC methods (in Appendix C), although LNG-IUS and subdermal implants can prevent more unintended pregnancies, abortions, and births among adolescents, their costs are higher. Compared with IUD, the ICER for LNG-IUS is not cost-effective (\u0026gt;3 per capita GDP), while the ICER for subdermal implants is RMB 228089.16, which has a certain cost-effectiveness (\u0026lt;3 per capita GDP). However, compared with LNG-IUS, the ICER for subdermal implants is RMB 61780.11, which is very cost-effective (\u0026lt;1 per capita GDP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne-way sensitivity analysis\u003c/p\u003e\n\u003cp\u003eComparing COC with IUD or LNG-IUS, the cost of contraception with COC, IUD or LNG-IUS is the main factor affecting the baseline results. When comparing COC with subdermal implants, the main factor affecting the baseline results is the probability of contraceptive failure with COC. The tornado diagrams for each outcome are illustrated in Appendix D.\u003c/p\u003e\n\u003cp\u003eProbabilistic sensitivity analyses\u003c/p\u003e\n\u003cp\u003eComparing COC with various LARC methods, under the threshold of 1 times per capita GDP, each LARC contraceptive method is more cost-effectiveness, and the most of the scatter points fall below the threshold line, which indicates robust results. Comparing different LARC methods, under the threshold of 1 times per capita GDP, IUD is more cost-effectiveness, and the most of the scatter points fall below the threshold line, which indicates robust results. The scatterplot for each outcome are illustrated in Appendix D.\u003c/p\u003e\n\u003cp\u003eThe acceptability curve results show that under the threshold of 3 times per capita GDP, IUD is always cost-effectiveness. When WTP=RMB18765.18, the likelihood of IUD being the optimal strategy is close to 100%. However, when WTP exceeds RMB 20000, the likelihood of IUD being the optimal strategy decreases, and the likelihood of LNG-IUS and subdermal implant being the optimal strategy continues to increase. When WTP is 3 times the per capita GDP, the likelihood of IUD, subdermal implant, and LNG-IUS being the optimal strategy is 52.7%, 31.2%, and 16.1% respectively (see Figure 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a comprehensive evaluation of contraceptive strategies for Chinese adolescents, offering insights into cost-effective options to help reduce unintended pregnancies and improve health outcomes. Based on the perspective of health system, a decision-tree model was developed to assess the cost-effectiveness of COC and LARC contraceptive methods for adolescents. This analysis aims to promote the adoption of more economical and effective contraceptive methods among adolescents to prevent unintended pregnancy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results indicates that within five years, compared with COC, IUD can prevent more unintended pregnancies, abortions and births at a lower cost among adolescents. Similarly, LNG-IUS and subdermal implant also demonstrate strong cost-effectiveness. This is consistent with the research in the United States[\u003csup\u003e34]\u003c/sup\u003e, Brazil\u003csup\u003e[19]\u003c/sup\u003e and Britain\u003csup\u003e[22]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAmong the four contraceptive methods, subdermal implant offers the highest contraceptive effectiveness, IUD has the lowest contraceptive cost. IUD is dominant in terms of cost-effectiveness among the four contraceptive strategies. COC, as one of the typical contraceptive methods for teenagers, IUD, LNG-IUS and subdermal implant are more cost-effectiveness over five-year use conditions in this model. Although LNG-IUS and subdermal implant can prevent more adolescents from getting pregnant, they come at a higher cost. Overall, LARC is a contraceptive measure that is more suitable for long-term contraception in adolescents.\u003c/p\u003e\n\u003cp\u003eIn one-way sensitivity analysis, the probability of subdermal implant contraceptive failure is consistently lower than the COC\u0026rsquo;s, making the probability of COC contraceptive failure is the main factor affecting baseline results. The higher the probability, the greater the impact on outcomes. In probability sensitivity analysis, when WTP\u0026lt;RMB 20000, COC may be the preferred option compared to the LNG-IUS and subdermal implants.\u003c/p\u003e\n\u003cp\u003eRecent years, Chinese adolescents have become more open in their attitudes towards sexual behavior, with trends showing younger ages of sexual initiation. However, due to inconvenient access to contraceptives, previous uncomfortable sexual experiences, and a sense of invulnerability, it is easy for adolescents to get pregnant unexpectedly[\u003csup\u003e35]\u003c/sup\u003e. At the same time, adolescents lack knowledge and education about sexual and reproductive health[\u003csup\u003e36]\u003c/sup\u003e, which makes the proportion of repeated abortions among teenagers increase. Faced with the high incidence of unintended pregnancy and the increasing demand for contraception in China, it is crucial to encourage adolescents to adopt LARC method, especially IUD, which can not only meet the needs of adolescents, reduce the incidence of unintended pregnancy and save costs, but also offer significant long-term health benefits, supporting adolescents\u0026apos; future development and contributing to social progress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations. Firstly, it does not account for the issue of repeat pregnancies, a constraint imposed by the lack of available data. Secondly, the model overlooks the cost of adverse reactions associated with different contraceptive methods and the long-term economic and social value derived from preventing unintended pregnancies among teenagers. The former issue may lead to an underestimation of the contraceptive costs for teenagers, while the latter may result in an underestimation of the contraceptive effectiveness for this age group. However, overall, the benefits of preventing unintended pregnancies in teenagers are likely to be higher.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWL participated in the design of the study, performed the data analyses and drafted the initial manuscript; DW was responsible for data handling and supported the data analysis; GX participated in the design of the study and reviewed and revised the manuscript; LZ. participated in the design of the analysis and participated in the drafting of the manuscript and reviewed and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSully EA, Biddlecom A, Daroch J, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019[Internet]. New York: Guttmacher Institute; 2020[cited 2024 Sep 17]. Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019.\u003c/li\u003e\n\u003cli\u003eHaakenstad A, Angelino O, Irvine CMS, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022 Jul 23;400(10348):295-327. DOI: 10.1016/S0140-6736(22)00936-9.\u003c/li\u003e\n\u003cli\u003eSedgh, G., Finer, L. B., et al. Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health, 56(2), 223-230. DOI: 10.1016/j.jadohealth.2014.09.007.\u003c/li\u003e\n\u003cli\u003eWHO[Internet]. Adolescent pregnancy; c2020[cited 2024 Sep 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy.\u003c/li\u003e\n\u003cli\u003eUnited Nations Population Fund[Internet]. Motherhood in childhood: Facing the challenge of adolescent pregnancy; c2013[cited 2024 Sep 17]. Available from: https://unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013.pdf\u003c/li\u003e\n\u003cli\u003eZheng XY, Cheng G. Survey of Youth Access to Reproductive Health in China. Population and Development. 2010 May 29;16(3):2-16. (in Chinese).\u003c/li\u003e\n\u003cli\u003eZhao R, Zhang R, Fu XX, et al. Sexual and reproductive health related knowledge, attitude and behavior among senior high school and college students in 11 provinces and municipalities of China. Chinese Journal of Public Health. 2019 Aug 6;35(10):1330-1338. (in Chinese).\u003c/li\u003e\n\u003cli\u003eChinese Society of Family Planning of Chinese Medical Association, National Research Institute for Family Planning. Guidelines for adolescent contraceptive services. Chinese Journal of Obstetrics and Gynecology. 2020 Feb 5;55(2):83-90. DOI:10.3760/cma.j.issn.0529-567X.2020.02.005. (in Chinese).\u003c/li\u003e\n\u003cli\u003eLiu XM. Ensure the reproductive health of adolescents is not compromised. Journal of the Chinese People\u0026apos;s Political Consultative Conference. 2022 Feb 23;02-23(005). DOI:10.28660/n.cnki.nrmzx.2022.001041. (in Chinese).\u003c/li\u003e\n\u003cli\u003eLu MQ, Liu WL. International experience and enlightenment on the development of comprehensive sex education. New Curriculum Review. 2018 Aug 15;(Z1):176-185. (in Chinese).\u003c/li\u003e\n\u003cli\u003evan der Doef S, Reinders J. Stepwise sexual development of adolescents: the Dutch approach to sexuality education. Nat Rev Urol. 2018 Mar;15(3):133-134. DOI: 10.1038/nrurol.2018.3. \u003c/li\u003e\n\u003cli\u003eGoldfarb ES, Lieberman LD. Three Decades of Research: The Case for Comprehensive Sex Education. J Adolesc Health. 2021 Jan;68(1):13-27. DOI: 10.1016/j.jadohealth.2020.07.036. Epub 2020 Oct 12.\u003c/li\u003e\n\u003cli\u003eZhang YS, Zhang XX. Li XY, et al. (2020). Chinese Journal of Family Planning \u0026amp; Gynecotokology. 2020 Apr 25;12(04):4-6. (in Chinese).\u003c/li\u003e\n\u003cli\u003eGu XY, Che Y. Insight of the big data about artificial abortion and contraception in family planning work after the birth control policy was eased in China. Chinese Journal of Practical Gynecology and Obstetrics. 2018 Jau 2;34(1):46-51. (in Chinese).\u003c/li\u003e\n\u003cli\u003eColes CB, Shubkin CD. Effective, recommended, underutilized: a review of the literature on barriers to adolescent usage of long-acting reversible contraceptive methods. Curr Opin Pediatr. 2018 Oct;30(5):683-688. DOI: 10.1097/MOP.0000000000000663.\u003c/li\u003e\n\u003cli\u003eZhuang WM, Ji F, Li HJ, Zhang KH. Awareness and usage of long-acting reversible contraception in adolescents. Chinese Preventive Medicine. 2022 Aug 31;23(12):949-955. DOI:10.16506/j.1009-6639.2022.12.011. (in Chinese).\u003c/li\u003e\n\u003cli\u003eSteyn PS, Goldstuck ND. Contraceptive needs of the adolescent. Best Pract Res Clin Obstet Gynaecol. 2014 Aug;28(6):891-901. DOI: 10.1016/j.bpobgyn.2014.04.012. \u003c/li\u003e\n\u003cli\u003eRosenthal MA, McQuillan SK. Adolescent contraception. CMAJ. 2021 Aug 9;193(31):E1218. DOI: 10.1503/cmaj.202413.\u003c/li\u003e\n\u003cli\u003eFarah D, de Moraes Andrade TR, Sansone D, et al. A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System. Am J Prev Med. 2022 Jan;62(1):114-121. DOI: 10.1016/j.amepre.2021.06.023\u003c/li\u003e\n\u003cli\u003eKim CS, Lunde B, MacIsaac L, et al. Provision of contraceptive implants in school-based health centers: A cost-effectiveness analysis. Contraception. 2021 Feb;103(2):107-112. DOI: 10.1016/j.contraception.2020.11.009.\u003c/li\u003e\n\u003cli\u003eEisenberg D, McNicholas C, Peipert JF. Cost as a barrier to long-acting reversible contraceptive (LARC) use in adolescents. J Adolesc Health. 2013 Apr;52(4 Suppl):S59-63. DOI: 10.1016/j.jadohealth.2013.01.012.\u003c/li\u003e\n\u003cli\u003eMavranezouli I; LARC Guideline Development Group. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod. 2008 Jun;23(6):1338-45. DOI: 10.1093/humrep/den091.\u003c/li\u003e\n\u003cli\u003eWHO[Internet]. Health data overview for the People\u0026rsquo;s Republic of China. c2024[cited 2024 Sep 17]. Available from: https://data.who.int/countries/156.\u003c/li\u003e\n\u003cli\u003eChinese Pharmaceutical Association[Internet]. China Guidelines for Pharmacoeconomic Evaluations(2020). c2020[cited 2024 Sep 17]. Available from: https://www.cpa.org.cn/cpadmn/attached/file/20201203/1606977380634185.pdf.\u003c/li\u003e\n\u003cli\u003eUNFPA China[Internet]. Ending Unintended Pregnancies among Chinese Youth by 2030. c2018[cited 2024 Sep 17]. Available from: https://china.unfpa.org/sites/default/files/pub-pdf/Ending%20Unintended%20Pregnancies%20among%20Chinese%20Unmarried%20Youth%20by%202030-Final.pdf\u003c/li\u003e\n\u003cli\u003eZhao XR, Gao JL, Liu CP, et al. Health Economics Evaluation of Post-abortion Care and Routine Care Service after Abortion for Patients with Unwanted Pregnancy. Chinese Health Economics. 2022 Jul 5;41(07):71-76. (in Chinese).\u003c/li\u003e\n\u003cli\u003eNational Bureau of Statistics[Internet]. How to divide the East, Central, and Western Economic Belt, and how to include the three provinces of Northeast China in the East, Central, and Western Regions?. c2021[cited 2024 Sep 17]. Available from: https://www.stats.gov.cn/hd/lyzx/zxgk/202107/t20210730_1820095.html.\u003c/li\u003e\n\u003cli\u003eJiangsu Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jiangsu Province (2023). c2024. [cited 2024 Sep 17]. Available from: https://ybj.jiangsu.gov.cn/module/download/downfile.jsp?classid=0\u0026amp;filename=32fe93ac99f04b7da06b\u003csup\u003e141\u003c/sup\u003e905596b.pdf.\u003c/li\u003e\n\u003cli\u003eJiangxi Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jiangxi Province(2023). c2023. [cited 2024 Sep 17]. Available from: https://www.jiangxi.gov.cn/art/2023/12/4/art_65599_4743365.html.\u003c/li\u003e\n\u003cli\u003eShanxi Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Shanxi Province (2024). c2024. [cited 2024 Sep 17]. Available from: http://ybj.shaanxi.gov.cn/zwgk/sjfb/ylby/33516.htm.\u003c/li\u003e\n\u003cli\u003eJilin Provincial Healthcare Security Administration[Internet]. List of Medical Service Price Items in Jilin Province (2023). C2023[cited 2024 Sep 17]. Available from: https://xxgk.jl.gov.cn/zsjg/fgw/xxgkmlqy/202312/t20231227_8857684.html.\u003c/li\u003e\n\u003cli\u003eNational Health Commission of the People\u0026rsquo;s Republic of China[Internet]. 2022 China Health Statistics Yearbook. c2023[cited 2024 Sep 17]. Available from: http://www.nhc.gov.cn/mohwsbwstjxxzx/tjtjnj/202305/6ef68aac6bd14c1eb9375e01a0faa1fb/files/b05b3d958fc546d98261d165ce\u003csup\u003e4\u003c/sup\u003edba.pdf.\u003c/li\u003e\n\u003cli\u003eNational Bureau of Statistics[Internet]. Statistical Bulletin on National Economic and Social Development of the People\u0026apos;s Republic of China in 2023. C2024[cited 2024 Sep 17]. Available from: https://www.stats.gov.cn/sj/zxfb/202402/t20240228_1947915.html. \u003c/li\u003e\n\u003cli\u003eTrussell J, Hassan F, Lowin J, et al. Achieving cost-neutrality with long-acting reversible contraceptive methods. Contraception. 2015 Jan;91(1):49-56. DOI: 10.1016/j.contraception.2014.08.011.\u003c/li\u003e\n\u003cli\u003eZhang N, Zhang SN, Tian ST, et al. The current contraceptice situation and the contraceptive guidance for the adolescents client of induced abortion. Chinese Journal of Family Planning. 2024 Feb 15;32(02):460-463. (in Chinese).\u003c/li\u003e\n\u003cli\u003eNie Y, Zheng RM, Luo XM, Xu YW. (2022). Investigation and analysis of sexual development situation and knowledge, attitude and behavior about sexual and reproductive health of 15415 adolescents in China. Chinese Journal of Woman and Child Health Research. 2022 Apr 25;33(04):68-74. (in Chinese).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescents, Contraceptive methods, Unintended pregnancies, Cost-effectiveness analysis, Decision-tree model","lastPublishedDoi":"10.21203/rs.3.rs-5393510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5393510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe problem of unintended pregnancy among adolescent spreads worldwide. In this study, a decision-tree model was constructed to analyze the cost and effectiveness of different contraceptive methods in Chinese adolescents to avoid unintended pregnancy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFrom a healthcare system perspective, evaluate the cost and effectiveness of combined oral contraceptive (COC), intrauterine device (IUD), levonorgestrel intrauterine system (LNG-IUS) and subdermal implant contraceptive methods used by 14.88\u0026nbsp;million women aged 15\u0026ndash;24 years with contraceptive needs within 5 years in 2023. The cost parameters are derived from the China Medical Information Platform and healthcare service price literature. Effectiveness refers to avoided pregnancies, abortions, and births. The clinical parameters are derived from the WHO and published literature. Cost-effectiveness analysis is used to determine whether contraception measures are economical. Univariate sensitivity analysis and probabilistic sensitivity analysis verify the robustness of the model.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe cost of IUD is the lowest, and subdermal implant has the highest number of unintended pregnancies. The cost-effectiveness ratio shows that IUD has the best contraceptive effect, and it costs RMB 369.67 to avoid accidental pregnancy among adolescents. Compared with COC, IUD has significant contraceptive advantages and can achieve better clinical results at lower cost. LNG-IUS and subdermal implant are economical when compared with COC, with ICER of 7556.78 and 12271.85, both of which are lower than the GDP per head of China.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFaced with the growing demand for contraception among adolescents and high incidence of unintended pregnancies, adolescents can be encouraged to adopt LARC methods, especially IUD.\u003c/p\u003e","manuscriptTitle":"Cost-effectiveness of different contraceptive methods to avoid unintended pregnancy among adolescents in China: A modeling analysis based on decision-tree modle","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 10:42:00","doi":"10.21203/rs.3.rs-5393510/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"212e3804-929a-4c9e-b509-c10386d811d5","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-29T03:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-19 10:42:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5393510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5393510","identity":"rs-5393510","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}