[Cost of family planning care in 10-19 years old teenagers]. / Costo de atención por servicios de planificación familiar a adolescentes de 10-19 años.

Objetives: To identify the costs of family planning care in adolescents. Material and methods: Longitudinal study of the cost of care for family planning carried out in 2015 in a group of individuals with age limits of 10 and 19 years in a unit first level of health care in the state of Queretaro, Mexico. The profile of use of family planning (FP) was created for the teen was performed services through counseling, provision of contraception and review of intrauterine device (IUD) in a year; cost projections for the population of adolescents and different coverage scenarios between 5 and 100% were made. Results: The average annual cost was 228.84 Mexican pesos. Ideally the identified cost was 2,708.94 pesos. The projection with 20 % coverage was 207,251,330 pesos. The average annual family planning consultations was 0.9. The most commonly used method was with medroxyprogesterone-estradiol at doses of 25 and 5 mg. Conclusion: The cost of planning in adolescents is low, taking into account the costs that the care of high-risk pregnancies and associated comorbidities.

Economic impact of Tibolone compared with Continuous-Combined Hormone Replacement Therapy in the management of climacteric symptoms in postmenopausal women.

BACKGROUND: Deciding whether to treat postmenopausal women suffering from climacteric symptoms with Continuous Combined Hormone Replacement Therapy (CCHRT) has become increasingly difficult after the release of the Women's Health Initiative results. As a result, development of alternatives to CCHRT is required. Tibolone, which is a synthetic steroid that has estrogenic, progestogenic and androgenic properties, is reported to be a promising alternative. It has been used in Europe, in the same indication as CCHRT, for approximately 20 years but is not yet available in Canada. OBJECTIVE: We carried out a cost-utility analysis comparing a 3-year-treatment course with Tibolone 2.5mg and conjugated equine estrogens (CEE)/medroxyprogesterone acetate (MPA) (0.625 mg/2.5 mg) in the management of postmenopausal women with climacteric symptoms. METHODS: A Markov model, considering persistence, vaginal bleeding and climacteric symptoms, was elaborated to compare the different options in terms of cost and Quality Adjusted Life Years (QALYs), according to a public third-party payer perspective. RESULTS: Compared with CEE/MPA, Tibolone led to an increase in cost (dollars 485 for Tibolone versus dollars 232 for CEE/MPA) and a slight increase in QALYs (2.08 for Tibolone versus 2.05 for CEE/MPA). Consequently, the incremental cost per QALY gained ratio was dollars 9198. CONCLUSION: According to the results, Tibolone seems to be a cost-effective alternative to CEE/MPA. However, those results should be interpreted with caution insofar as the difference in terms of QALY is clinically difficult to value and taking into account the limited data on Tibolone's long-term innocuity.

Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women.

BACKGROUND: Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration. OBJECTIVE: The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women. METHODS: This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss. RESULTS: A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively. CONCLUSIONS: MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.

Contraception update: implantable and injectable methods.

There are currently more options available to pediatricians caring for sexually active adolescents who wish to prevent pregnancy. The two progestin-only methods, levonorgestrel subdermal implants and DMPA injections, minimize or entirely remove the obstacle of patient compliance from contraceptive efficacy. Adolescents considering a progestin-only method of contraception should be counseled explicitly about the likelihood of menstrual irregularity with use. Perhaps more importantly, adolescents should be reminded that hormonal methods of contraception do not provide protection from sexually transmitted disease. Thus, male condom use should not only be recommended, but also concrete discussion and instruction on appropriate use should be given.

PIP: Two new progestin-only contraceptive methods--levonorgestrel subdermal implants and Depo-Provera injection--have the potential to overcome adolescents' traditional poor compliance with family planning methods. Both methods provide safe, highly effective, reversible fertility control, but require virtually no ongoing patient compliance. The levonorgestrel implants provide continuous contraception for up to five years and have a failure rate under 1%. The primary side effect is an alteration in menstrual patterns: prolonged bleeding in 40%, irregular bleeding in 38%, intermenstrual spotting in 32%, more frequent bleeding in 16%, and amenorrhea in 12%. An average weight gain of five pounds over the five-year period of use is expectable given the appetite stimulation associated with progestins. Depo-Provera, injected every three months, has a failure rate of 0.1-0.7% in the first year of use. Amenorrhea is the most commonly reported menstrual side effect. Although both methods are highly effective in preventing pregnancy, they confer no protection against sexually transmitted diseases; thus, adolescent acceptors should be counseled to use condoms concomitantly.