The Effects of Postpartum Long-Acting Reversible Contraceptive Insertion From the Medicaid Payer Perspective [26J

Abstract

INTRODUCTION: This Markov model was created to determine the difference in unintended pregnancies, costs, and cost effectiveness with immediate versus standard placement of postpartum long-acting reversible contraception (ppLARC), which includes intrauterine devices (IUDs) and implants. METHODS: This Markov model examines a theoretical cohort of 1,000 women whose obstetrical care was paid for by North Carolina Medicaid and who requested ppLARC prior to discharge from their delivery hospitalization from the perspective of NC Medicaid. Probability inputs came from the literature and cost inputs are from NC Medicaid fee schedules. Markov cycles were weekly with an 18 month time horizon. During the time horizon postpartum, a woman could continue with her current contraceptive method, change to a different method, or become pregnant. Pregnancy is an absorbing state with five different outcomes. Probabilistic sensitivity analyses were conducted on key model parameters. RESULTS: Immediate ppLARC would result in 182 fewer unintended pregnancies and save North Carolina $624,372 over two years. Immediate ppLARC was cost saving, with an ICER of $3,435 saved per unintended pregnancy prevented. In sensitivity analyses, immediate ppLARC remained cost saving except when parameters were varied widely from expected values. CONCLUSION: Immediate post-partum insertion of long-acting reversible contraceptives was found to be associated with cost-savings and fewer unintended pregnancies.