{
  "abstract": "Abstract Objective To estimate effects of a policy introducing universal, no-cost public coverage for prescription contraception on use in British Columbia, Canada.Design Population based, controlled, interrupted time series analysis.Setting 10 Canadian provinces.Participants Prescription medications dispensed to reproductive aged (15-49 years) female residents of British Columbia, Canada, compared with a synthetic control derived from the nine other Canadian provinces and a population based cohort of 859 845 female individuals in British Columbia (age 15-49 years) between 1 April 2021 and 30 June 2024.Intervention Introduction of a universal contraception coverage policy in April 2023, where the public insurer pays 100% of prescription costs.Outcome measures Number of monthly dispensations for long-acting reversible contraception (LARC) and number of monthly dispensations for all forms of prescription contraception (including LARC), percentage of reproductive aged female residents using LARC and using all forms of prescription contraception, and the proportion of people using prescription contraception who use LARC (LARC market share). Segmented regression models were used to estimate policy effects by comparing the expected outcome values after 15 months of the policy (ie, the counterfactual, derived from trends before the policy and changes in the control) with the observed values, with 95% confidence intervals (CIs) estimated using bootstrapping.Results In April 2021, 3249 (95% CI 3066 to 3391) LARC prescriptions were dispensed in British Columbia, with a declining slope trend of −17 (−30 to −7) fewer dispensed per month before the policy. Monthly LARC dispensations increased by 1050 (942 to 1487) immediately after British Columbia’s policy change and saw a steady increasing trend after the policy introduction. An additional 1273 (963 to 1698) monthly LARC prescriptions were dispensed 15 months after policy implementation compared with the expected volume, representing an estimated 1.49-fold (1.34 to 1.77) increase. Dispensations for all prescription contraception (including LARC) increased by 1981 (356 to 3324) per month, representing a 1.04-fold (1.01 to 1.07) increase. Among the 859 845 female residents aged 15-49 years in the population, 9.1% were using LARC in April 2021. 15 months after the policy, 11 375 (10 273 to 13 013) more individuals were using LARC than expected without the policy, representing an additional 1.3% (1.2% to 1.5%) of the population. The policy led to an additional 1.7% (1.5% to 2.3%) of the population using any prescription contraception. 15 months after the policy, the LARC market share was 1.9% (1.2% to 2.3%) higher than expected.Conclusions Universal, no-cost public coverage in British Columbia increased prescription contraception use overall, driven by increased LARC use. As such, cost seems to be an important contributor to contraception use and method selection at the population level.",
  "authors": [
    {
      "affiliations": [
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Laura Schummers"
    },
    {
      "affiliations": [
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada",
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Lucy Cheng"
    },
    {
      "affiliations": [
        "Pharmaceutical Analytics, Corporate Services Division, Ministry of Health, Government of British Columbia, Victoria, BC, Canada"
      ],
      "name": "Martin Odendaal"
    },
    {
      "affiliations": [
        "Pharmaceutical Analytics, Corporate Services Division, Ministry of Health, Government of British Columbia, Victoria, BC, Canada"
      ],
      "name": "Elisabet Rodriguez-Llorian"
    },
    {
      "affiliations": [
        "Health System Policy and Oversight Division, Ministry of Health, Government of British Columbia, Victoria, BC, Canada"
      ],
      "name": "I Fan Kuo"
    },
    {
      "affiliations": [
        "Department of Family Practice, University of British Columbia, Vancouver, BC, Canada",
        "Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK"
      ],
      "name": "Wendy V Norman"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada"
      ],
      "name": "Amanda Black"
    },
    {
      "affiliations": [
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada",
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Andrea Stucchi"
    },
    {
      "affiliations": [
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada",
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Mary Helmer-Smith"
    },
    {
      "affiliations": [
        "Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada",
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Elizabeth Nethery"
    },
    {
      "affiliations": [
        "Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada",
        "Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada"
      ],
      "name": "Amanda Downey"
    },
    {
      "affiliations": [
        "Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada"
      ],
      "name": "G Emmanuel Guindon"
    },
    {
      "affiliations": [
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Kim McGrail"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada",
        "Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada"
      ],
      "name": "Erin A Brennand"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Sabrina Lee"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada"
      ],
      "name": "Amy Metcalfe"
    },
    {
      "affiliations": [
        "School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada",
        "Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada"
      ],
      "name": "Stirling Bryan"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada"
      ],
      "name": "Elizabeth K Darling"
    },
    {
      "affiliations": [
        "Department of Geography, University of Calgary, Calgary, AB, Canada"
      ],
      "name": "Stefania Bertazzon"
    },
    {
      "affiliations": [
        "Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada"
      ],
      "name": "Vanessa Poliquin"
    },
    {
      "affiliations": [
        "Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada"
      ],
      "name": "Nathan C Nickel"
    },
    {
      "affiliations": [
        "Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada"
      ],
      "name": "Fiona Clement"
    },
    {
      "affiliations": [
        "Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada"
      ],
      "name": "Michael R Law"
    }
  ],
  "title": "Effect of universal no-cost coverage on use of long-acting reversible contraception and all prescription contraception: population based, controlled, interrupted time series analysis",
  "uid": "e905513a-7100-5ae3-85bf-633bbd530e84"
}