Achieving cost-neutrality with long-acting reversible contraceptive methods

James Trussell,Fareen Hassan,Julia Lowin,Amy Law,Anna Filonenko

doi:10.1016/j.contraception.2014.08.011

James Trussell, Fareen Hassan + Show 3 more

Open Access

https://doi.org/10.1016/j.contraception.2014.08.011

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Abstract

ObjectivesThis 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 designA 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/24h (total content 52mg)]. 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. ResultsThe two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1years of LARC usage would result in cost-savings compared to SARC usage. ConclusionsThis 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 3years of use. ImplicationsPrevious 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 3years.

Highlights

Unintended pregnancy (UP) is a substantial public health problem in the United States leading to a sizeable, and potentially avoidable, cost burden [1]
This analysis finds that even if Long-acting reversible contraceptive (LARC) methods are not used for their full durations of efficacy, they become cost-saving relative to short-acting reversible contraceptive (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

Summary

Introduction

Unintended pregnancy (UP) is a substantial public health problem in the United States leading to a sizeable, and potentially avoidable, cost burden [1]. Of women using reversible contraception in the United States, 55% use SARC methods, 27% use barrier methods (mainly condoms), 10% use natural methods such as withdrawal or periodic abstinence, while only 9% use LARC methods [7]. These various methods vary greatly in their effectiveness, duration of effect, level of required user adherence and overall cost [6]. LARC methods [the copper intrauterine device (IUD), hormonal intrauterine systems (IUSs) and implant] require administration much less frequently (once every 3 to 10 years), and their effectiveness is not reliant upon user adherence [6]

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