Achieving cost-neutrality with long-acting reversible contraceptive methods

Abstract

Objectives This analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation. Study design A three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20–29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods. Results The two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage. Conclusions This analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use. Implications Previous economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years.

Reproductive Life Plan Counseling and Effective Contraceptive Use among Urban Women Utilizing Title X Services

“…Thus, provider-patient interactions play a critical role in an individual's decision to use an effective contraceptive method (Dehlendorf, Kimport, Levy, & Steinauer, 2014a;Kavanaugh, Frowirth, Jerman, Popkin, & Ethier, 2013). Finally, because effective contraceptive methods can have prohibitively high up-front costs, economic capital is an important factor in considering certain methods over others (Dennis & Grossman, 2012;Trussell, Hassan, Lowin, Law, & Filonenko, 2015).…”

Continuation of copper and levonorgestrel intrauterine devices: a retrospective cohort study

“…Although continuation rates in this study were somewhat lower than shown in some prior studies, we found a median use of >3 years. Modeling studies have shown that IUDs become among the most cost-effective methods after 3 years of use 4 ; therefore, even with the typical use seen in our study, IUDs are still among the most cost-effective contraceptive methods. Continued efforts to increase uptake and continuation of IUDs will improve women's ability to control their reproduction and result in cost savings for the health system.…”

“…3 IUDs are highly cost-effective contraceptives. 4 Given their high efficacy, ease of use, and cost-effectiveness, IUDs have great potential to prevent undesired pregnancy 5 and to allow women to exercise autonomy over their reproductive health.…”

Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016

“…When considering additional benefits from preventing unintended pregnancies not desired at a later time, the intervention is cost-saving in all scenarios. Previous studies have shown that expanding access to contraception, especially LARC, is cost-saving ( 16 , 37 , 38 ). Likewise, our findings suggest that this intervention could be cost-saving or cost-effective within the context of a public health emergency response.…”

“…The latter comprised the costs of contraception methods and related office visits and services (e.g., insertion and removal of LARC for new method users resulting from the intervention and the cost of more intensive counseling for all women receiving contraceptive services during the intervention). We took the 1-year costs for contraception methods from the literature ( 16 , 29 ) and based the other program costs on the estimated costs for a pilot program planned to increase access to contraception in Puerto Rico as part of the current Zika virus outbreak response ( 30 ). We did not apply a discount rate to intervention costs because of the time horizon of 12 months.…”