Retrospective analysis of the impact of increasing access to long acting reversible contraceptives in a commercially insured population.

Amy Law,Dominic Pilon,Richard Lynen,Mei Sheng Duh,Patrick Lefebvre,Laurence Gozalo,François Laliberté

doi:10.1186/s12978-016-0211-3

Abstract

BackgroundUnintended pregnancies have been shown to be associated with high costs for the healthcare system, among other adverse impacts, but could still account for up to 51 % of pregnancies in the US. Improvements in contraception among women are needed. Long acting reversible contraceptives (LARCs), which have proved their safety and efficacy, have been found to significantly decrease the risk of unintended pregnancy. Yet they are still marginally employed. This study aims at investigating the evolution of LARC use over 15 years and at assessing the impact of the introduction of newer LARCs on LARC use relative to all contraceptive use.MethodsThis retrospective study identified women with LARC or short acting reversible contraceptive (SARC) claims from a US insurance claims database (01/1999-03/2014). Yearly proportions of LARC users relative to all contraceptive users were reported. Generalized estimating equation models were used to assess the impact of user characteristics, such as age group (15–17, 18–24, 25–34, and 35–44), and of time periods related to the introduction of new LARCs (01/2001: Mirena, 07/2006: Implanon, 01/2013: Skyla) on LARC use.ResultsA total of 1,040,978 women were selected. LARC use increased yearly from 0.6 % (1999) to 16.6 % (2013) among contraceptive users. Time periods associated with the introduction of a newer LARC were significant predictors of LARC use; women in 2006-2012 and 2013-2014 were respectively 3.7-fold (95 % CI:3.57–3.74) and 6.6-fold (95 % CI:6.43–6.80) more likely to use LARCs over SARCs relative to women in 2001-2006. The increase in LARC use was especially pronounced in young women. Compared to women aged 18–24 in 2001-2006, women aged 18–24 in 2006-2012 and 2013-2014 were respectively 6.4-fold (95 % CI:5.91–6.86) and 14.7-fold (95 % CI:13.59–15.89) more likely to use LARCs over SARCs.ConclusionsThis broadly representative commercial claim-based study showed that the proportion of privately insured women of childbearing age using LARCs increased over time and that the introduction of newer LARCs corresponded with significant increases in overall LARC use. Future research is needed to assess LARC use in uninsured or publicly-insured populations.

Highlights

Unintended pregnancies have been shown to be associated with high costs for the healthcare system, among other adverse impacts, but could still account for up to 51 % of pregnancies in the United States (US)
Population baseline characteristics A total of 1,040,978 women were identified to assess the evolution of proportion of long acting reversible contraception (LARC) use over time (Fig. 1), while 732,430 women were selected for analyses that used information collected prior to contraceptive claims (12 months of continuous health plan eligibility before a LARC or short acting reversible contraceptive (SARC) claim)
The plan type increased over time in the proportion of women covered by a point of service (POS) plan and decreased in the proportion of women covered by a preferred provider organization (PPO) plan

Summary

Introduction

Unintended pregnancies have been shown to be associated with high costs for the healthcare system, among other adverse impacts, but could still account for up to 51 % of pregnancies in the US. Long acting reversible contraceptives (LARCs), which have proved their safety and efficacy, have been found to significantly decrease the risk of unintended pregnancy. Unintended pregnancies have been shown to have adverse social, economic, and health outcomes for the mother, and for the child in cases where the pregnancy turned into live birth [3] Their burden on the healthcare system could be as high as $4.5 billion [4]. Long acting reversible contraception (LARC) methods, which solve issues related to adherence and incorrect use, could significantly help in reducing unintended pregnancies and their associated burdens [7, 8]

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