Three-year continuation of long-acting reversible contraceptive methods in a mixed-payer health care setting: a retrospective review

Abstract

Objectives: As long-acting reversible contraceptive (LARC) method use increases, accurate data on duration of use in clinical practice are needed. We aimed to estimate 3-year continuation for the levonorgestrel (LNG) IUD, copper (Cu) IUD and etonogestrel contraceptive implant in an academic health care system with mixed-payer reimbursement. Methods: This retrospective review assessed University of Utah Healthcare system patients who had an IUD or implant inserted between January 1, 2004 and December 31, 2011. IUD and implant users were identified by ICD-9 and CPT codes. We fitted a multivariable Poisson regression with robust variance estimates to relate patient characteristics to continuation beyond 3 years. Results: We obtained data on 7053 LARC device insertions to assess 3-year continuation. Three-year continuation incidences were 70.6%, 67.3% and 56.2% for the LNG-IUD, Cu-IUD and implant, respectively. Cu-IUD and LNG-IUD continuation did not differ significantly; however, both LNG-IUD and Cu-IUD users had a significantly higher 3-year continuation incidence than implant users (IRR, 1.19; 95% CI, 1.00–1.41; and IRR, 1.25; 95% CI, 1.09–1.43, respectively). Being older than 30 at insertion increased the incidence of 3-year continuation regardless of device (IRR, 1.10; 95% CI, 1.02–1.18), as did payment out of pocket (IRR, 1.22; 95% CI, 1.04–1.43). White women continued use beyond 3 years more often than non-White women (IRR, 1.12; 95% CI, 1.02–1.23). Ethnicity, parity and year of insertion were not associated with 3-year continuation. Conclusions: Two thirds of both LNG- and Cu-IUD users continued use for 3 years, which is a significantly longer duration than for implant users. Payer type, race and age were associated with 3-year continuation incidences in this population.