Immediate vs Routine Postpartum Intrauterine Device Placement After Teen Pregnancy: A Cost-Effectiveness Analysis [A02

Abstract

INTRODUCTION: The time surrounding a teen’s first pregnancy represents an ideal period to counsel on effective contraception and prevent additional unplanned pregnancies. It has yet to be examined if post placental intrauterine device (IUD) placement is cost effective in teenage patients relative to routine placement in the office. METHODS: A decision analytic model was built using TreeAge software to compare outcomes and costs among teenagers receiving either post placental or routine IUD placement. Outcomes, associated health care costs, and maternal quality-adjusted life years (QALY) were compared. All probabilities, utilities, and costs were derived from the literature. Costs were in 2021 US dollars with a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to assess how variation in baseline assumptions impacted model outputs. RESULTS: In a theoretical cohort of 300,000 teen births, post placental IUD placement yielded 35,620 more QALYs but cost $32 million more than routine placement. Post placental placement prevented 9,740 additional unplanned births—including 1585 preterm births—and 5595 abortions. Post placental placement was no longer cost effective when the likelihood of IUD removal within the next year rose from our baseline estimate of 0.14 to 0.46 or when the rate of subsequent unplanned teen pregnancy without an IUD fell to 0.007. CONCLUSION: Post placental IUD placement is cost effective for teenage patients from the maternal perspective. The cost effectiveness of the strategy is contingent on the likelihood of removal within the next year and of unplanned pregnancy without an IUD in place.