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Author Notes:

Rui Li, Email: rli@hrsa.gov

The Zika Contraception Access Network (Z-CAN) program was supported by the National Foundation for the Centers for Disease Control and Prevention, Inc. (CDC Foundation). This support was made possible through the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the William and Flora Hewlett Foundation, The Pfizer Foundation, and American College of Obstetricians and Gynecologists. The CDC Foundation also secured large-scale donations, offers of contraceptive products, support tools, and services from Bayer, Allergan, Medicines360, Americares and Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mylan, The Pfizer Foundation, Teva Pharmaceuticals, Church & Dwight Co., Inc., RB, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), Upstream USA, and Market Vision, Culture Inspired Marketing

The Z-CAN program would like to acknowledge the collaborative contributions of (in alphabetical order) the American College of Obstetricians and Gynecologists, the Beyond the Pill Program at the Bixby Center for Global Reproductive Health (University of California, San Francisco School of Medicine), Health Resources and Services Administration Office of Regional Operations, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), the Puerto Rico Department of Health, Puerto Rico Obstetrics and Gynecology, the Puerto Rico Primary Care Association, and Upstream USA. The funders and collaborators had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

The authors declare no conflict of interest.


Research Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Obstetrics & Gynecology
  • Contraception
  • Cost-effectiveness
  • Outbreak
  • Unintended pregnancy
  • Zika virus

Economic evaluation of Zika Contraception Access Network in Puerto Rico during the 2016-17 Zika virus outbreak


Journal Title:



Volume 107


, Pages 68-73

Type of Work:

Article | Post-print: After Peer Review


Objective: During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a preimplementation hypothetical cost-effectiveness analysis (CEA). Study Design: We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. Results: The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV–associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. Conclusion: Z-CAN was likely cost-saving in the context of a public health emergency response setting.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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