The correct level of public funding of sexual health services, particularly contraception and abortion (fertility control) remains controversial. As with other services, decision making requires appropriate evidence. This thesis, by reviewing current policy, identified two questions pertinent to decision makers in the English NHS, namely what is the cost and benefit of improving access to abortion and contraception. By critiquing current theory, as illustrated by the National Institute of Health and Clinical Evidence technology appraisal methods, it set out a new theory of evidence quality, defined according to its usefulness in decision making. General recommendations for economic evaluation were then deduced for dealing with uncertainty and measuring benefit, defined as the extent of fulfilment in decision makers' goals. In the empirical part of the thesis firstly, qualitative methods showed the range of measures of benefit, including access and user choice. Secondly, a systematic review of economic evaluations in fertility control showed their inadequacy in addressing the policy questions and made recommendations for economic evaluations specific to fertility control. Two economic evaluations were then conducted to examine the cost and consequences of improved access to contraception and abortion methods according to women's preferences. The first showed that greater choice of contraceptive methods could save up to £500 million over 15 years and reduce the annual number of unintended pregnancies by about 55,000 and annual number of abortions by about 22,000. The second showed that reducing the mean gestational age at abortion by about 9 days could increase the percentage of abortions within 10 weeks and save about £9 million over 15 years. Allowing women to choose medical abortion would produce greater savings. Sensitivity analyses largely supported these findings. Finally, limitations of the theoretical and empirical parts were discussed and recommendations for economic evaluation generally and specific to fertility control made.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:556009 |
| Date | January 2010 |
| Creators | Armstrong, Nigel |
| Publisher | University of Newcastle Upon Tyne |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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