Drug Utilization Study on Oral Contraceptives provided from Social Security, Buenos Aires-Argentina: Risk and cost analysis according to the type of combination used
Oral contraceptive pill is the most prescribed option to avoid birth-rate around the world. It is a combination of estrogens/progestin. Unfortunately, new combinations raise the risk of thrombosis. To determine the prescription profile and the incidence of thrombotic events associated to oral contraceptive use, we developed the present study. Method: It is a drug utilization study among beneficiaries of Buenos Aires Social Security Organization. Variables studied were age, sex, combination consumed, doses, co-morbidities, thrombotic events.Results: 69,653 women were enrolled in the study. 66,043 of them (94.84%) used new progestogen generation combination (desogestrel, gestodene, drospirenone,) while 3610 (5.18%) used either levonorgestrel or norgestrel as progestin. The number of thrombotic events (either depth vein thrombosis of lower limbs, thromboembolism or arterial thrombosis) was 77 (75 with new progestin and 2 using 1st/2nd generation options). Adjusting these values to 100,000 users; the occurrence of thrombotic events were doubled with new generation progestins when compared to older options. The price of the new generation combinations were 10.2 times more expensive that the safer ones. Conclusion: Among the beneficiaries of Buenos Aires State Social Security, the users of oral contraceptives with new generation progestin denote a greater risk of thrombotic events when compared with users of levonorgestrel or norgestrel. Public reproductive health policies that provide contraceptives to the population are crucial in guaranteeing rights such as avoiding unwanted pregnancies and reproductive planning. However, the combinations provided should not expose population to additional and unnecessary risks.
Keywords: oral contraceptives, thrombosis, progestin, risk, public health
2. Dragoman MV, Tepper NK, Fu R, Curtis KM, Chou R, Gaffield ME. 2018. A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception. Int J Gynaecol Obstet. 2018; 141(3):287–294.
3. Stegeman BH, de Bastos M, Rosendaal FR. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013; 347:f5298.
4. Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009; 339:b2890.
5. Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001–2009. BMJ. 2011; 343:d6423
6. WHO. Venous thromboembolic disease and combined oral contraceptives: results of international multicentre case-control study World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1995; 346(8990):1575–1582.
7. Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestogen components. Lancet 1995; 346 (8990):1589–1593.
8. Spitzer WO, Lewis MA, Heinemann LA, Thorogood M, MacRae KD. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. Transnational Research Group on Oral Contraceptives and the Health of Young Women. BMJ. 1996; 312 (7023):83–88.
9. Jennings V, Haile L, Simmons R, Spieler J, Shattuck D. Perfect- and typical-use effectiveness of the Dot fertility app over 13 cycles: results from a prospective contraceptive effectiveness trial, Eur J of Contrac & Reprod Health Care 2019; 24, 2:148-153.
10. CGP-ACOG -Committee on Gynecologic Practice ACOG Committee Opinion Number 540: Risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills. Obstet Gynecol. 2012; 120(5):1239–1242.
11. Lidegaard Ø, Milsom I, Geirsson RT, Skjeldestad FE. Hormonal contraception and venous thrombosis. Acta Obstet Gynecol Scand 2012; 91: 769-78.
12. Krattenmacher R, Knauthe R, Parczyk K, Walker A, Hilgenfeldt U, Fritzemeier KH. Estrogen action on hepatic synthesis of angiotensinogen and IGF-I: direct and indirect estrogen effects. J Steroid Biochem Mol Biol. 1994; 48(2–3):207–214.
13. Cagnacci A. Hormonal contraception: venous and arterial disease. Eur J Contracept Reprod Health Care. 2017; 22(3):191–199.
14. Fruzzetti F, De Negri F, Morale M. Activation of coagulation in smoking and non-smoking women using a third-generation oral contraceptive containing desogestrel. Eur J Contracept Reprod Health Care. 1999; 4(3):113–118.
15. Böttiger LE, Boman G, Eklund G, Westerholm B. Oral contraceptives and thromboembolic disease: effects of lowering oestrogen content. Lancet. 1980; 1(8178):1097–1101.
16. Swanepoel AC, Roberts HC, Soma P, Lindeque BG, Bester J. Hemorheological mechanisms for increased thrombosis in subjects using gestodene. Microsc Res Tech. 2018; 81(12):1489-1500.
17. Van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ. 2009; 339:b2921.
18. Dinger JC Oral contraceptive effectiveness according to body mass index, weight, age, and other factors. Am J Obstet Gynecol 2009; 201: 263.e1.
19. WHO. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. In. WHO Family Planning. 5th ed. 2015. Geneva, Switzerland. http://www.who.int/ reproductivehealth/publications/family _planning /MEC-5/en/ . Accessed June 8, 2020.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).