Pharmacy & Therapeutics - June 2008 - (Page 347)

DRUG FORECAST breast-feeding patients if the delivery was more than four weeks earlier.4–6 CONCLUSION The current trend in smaller family size throughout the world is resulting in an increased demand for contraceptive methods over an extended period of time.15 Some advantages of long-term contraceptives include the lack of the patient’s need to pay attention to them, their reliability without the need for strict patient compliance, their high efficacy, and their reversible ef fects after removal.15 Disadvantages of long-term contraception include dependence on properly trained health care personnel to initiate and end therapy, the requirement of minor surgery for insertion and removal of the implant, a high prevalence of bleeding irregularities, and the initial high cost.15 Implanon is a long-acting contraceptive method indicated for the prevention of pregnancy.4,15 In clinical trials, Implanon was safe, effective, and rapidly reversible.4 Because the most common reason for discontinuing therapy was related to abnormal bleeding, patient counseling with an emphasis on bleeding irregularities is essential.4,7,15 Informing patients extensively about all of the advantages and disadvantages of longacting contraception before implant insertion is important and optimizes success.4,7,15 9. COST ANALYSIS Pregnancy and childbirth have a significant impact on the cost of health care. Contraception adds to the cost of medications, but it saves money for health plans if it prevents an unintended pregnancy. Considering the major contraceptive dosage forms, the etonogestrel implant has been associated with a low number of pregnancies.1 An analysis was performed to determine the direct costs to health care plans for hormonal contraceptive products during a three-year inter val for 1,000 women.15 The analysis included annual pharmacy and medical costs, pregnancies resulting from contraceptive failure, and patients’ discontinuation of therapy.15 For etonogestrel, total costs after the first year were greatest as a result of the high number of patients who discontinued use during the first year.15 These patients drove the overall cost upward, because the costs associated with inserting and removing the implant occurred within the same year, with an appointment required to complete the procedure in both cases.15 The costs of the second and third year were approximately half those of the first year,15 thereby illustrating the importance of using this form of contraception for women seeking long-term protection. Even with the high cost of the first year, etonogestrel ranked second-lowest in cost.15 Other dosage forms evaluated were oral tablets, injections, the vaginal ring, transdermal deliver y systems, and IUDs.15 After a three-year period, extended-cycle oral contraceptives cost the most and IUD dosage forms cost the least.15 The long-acting, reversible form of contraception offered by etonogestrel is not only reliable; it also removes the dependence on the patient’s compliance and correct usage, which are required with other dosage forms.4 Cost effectiveness is also determined by the patient’s quality of life, acceptability of the device, stage of life, and past medical history.4 Regardless of the circumstances, any form of contraception must meet these requirements satisfactorily to provide true savings in health care.15 10. 11. 12. 13. 14. 15. 16. etonogestrel. Contraception 2005;71:319– 326. Zheng S, Zheng H, Qian S, et al. A randomized multicenter study comparing the efficacy and bleeding pattern of a single-rod (Implanon) and a six-capsule (Norplant) hormonal contraceptive implant. Contraception 1999;60:1–8. Brache V, Faundes A, Alvarez F, Cochon L. Nonmenstrual adverse events during use of implantable contraceptives for women: Data from clinical trials. Contraception 2002;65:63–74. Flores JB, Balderas ML, Bonilla MC, Vazquez-Estrada L. Clinical experience and acceptability of the etonogestrel subdermal contraceptive implant. Int J Gynecol Obstet 2005;90:228–233. Bitzer J, Tschudin S, Alder J. Acceptability and side effects of Implanon in Switzerland: A retrospective study by the Im planon Swiss Study Group. Eur J Contracept Reprod Health Care 2004;9: 278–284. Reinprayoon D, Taneepanichskul S, Bunyavejchevin S, et al. Effects of the etonogestrel-releasing contraceptive implant (Implanon) on parameters of breast-feeding compared to those of an intrauterine device. Contraception 2000;65:239–246. Diaz S. Contraceptive implants and lactation. Contraception 2003;65:39–46. AMCP Dossier for Implanon. Roseland, NJ: Organon USA, Inc.; 2006. Croxatto HB. Progestin implants. Steroids 2000;65:681–685. I REFERENCES 1. Varney SJ, Guest JF. Relative cost effectiveness of Depo-Provera, Implanon, and Mirena in reversible long-term hormonal contraception in the U.K. Pharmacoeconomics 2004;22(17):1141–1151. 2. Strauss LT, Gamble SB, Parker WY, et al. Abortion Surveillance—United States, 2003. Centers for Disease Control and Prevention. MMWR Surveill Summ 2006; 24:55(11):1–32. 3. Goodman and Gillman’s The Pharmacological Basis of Therapeutics. Available at: www.online.statref.com. Accessed January 26, 2007. 4. Etonogstrel (Implanon), package insert. Roseland, NJ: Organon USA, Inc.; 2006. 5. Micromedex Healthcare Series. Available at: www.thomsonhc.com. Accessed January 22, 2006. 6. Drug.com: Drug information online. Accessed January 22, 2006. 7. Croxatto HB, Urbancsek J, Massai R, et al. A multicentre efficacy and safety study of the single contraceptive implant Implanon. Hum Reprod 199;14(4):976– 981. 8. Funk S, Miller M, Mishell DR, et al. Safety and efficacy of Implanon, a singlerod implantable contraceptive containing ATTENTION, READERS! Too busy to write an article? Send us your ideas anyway. Contact Sonja Sherritze at: ssherritze@medimedia.com. Vol. 33 No. 6 • June 2008 • P&T® 347 http://www.online.statref.com http://www.thomsonhc.com http://Drug.com

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - June 2008

Editorial Aliskiren Reduces Plasma Renin Activity Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities California e-Pedigree Rules Pose Challenges For Pharmacies Pharmaceutical Approval Update American Psychiatric Association At a Glance: Dermatology Trends in Managed Care

Pharmacy & Therapeutics - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.