THE COST OF UNINTENDED PREGNANCIES IN CANADIAN ADOLESCENTS AND THE POTENTIAL IMPACT OF INCREASED USE OF LONG-ACTING REVERSIBLE CONTRACEPTIVES

Abstract

Objectives Unintended pregnancies (UPs) in adolescents significantlyimpact young women, their families/children, and society, however the full cost burden is currently not known. The objectives were to quantify the direct cost of UPs in Canadian adolescents, the proportion of UPs and cost attributable to imperfect contraceptive adherence, and estimate the potential cost savings with increased uptake of long-acting reversible contraceptives (LARCs) among adolescents. Methods A cost model was constructed to estimate the annual number and direct costs of UPs in adolescent women aged 15-19years.Adherence-associated UP rates were estimated using perfect- and typical-use failure rates. Change in annual number of UPs and impact on cost burden were projected in three scenarios of increased LARC use. One-way sensitivity analyses were conducted to assess impact of key variables on scenarios of increased LARC use. Results Among Canadian adolescents, there are more than 39,000 UPs annually. The associated direct cost was over $60 million; 61% of this cost ($37 million) was attributable to contraceptive non-adherence. Increased LARC uptake produced cost savings of over $3million in all three switching scenarios; the largest savings ($3.6 million) occurred when 10% of females using either a SARC or no method switched to LARCs. Minimum duration of LARC usage required before realizing cost savings was 6.8 months. Conclusions The cost of UPs in Canadian adolescents is significant and largely attributed to imperfect contraceptive adherence. Increased LARC uptake in adolescents may improve ongoing contraceptive adherence, thereby reducing rates of adolescent UP and generating significant cost savings in this age group.