Elsevier

Contraception

Volume 91, Issue 1, January 2015, Pages 49-56
Contraception

Original research article
Achieving cost-neutrality with long-acting reversible contraceptive methods

https://doi.org/10.1016/j.contraception.2014.08.011Get rights and content

Abstract

Objectives

This analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation.

Study design

A three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20–29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods.

Results

The two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage.

Conclusions

This analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use.

Implications

Previous economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years.

Introduction

Unintended pregnancy (UP) is a substantial public health problem in the United States leading to a sizeable, and potentially avoidable, cost burden [1]. Despite national public expenditure and investment on family planning services exceeding $2 billion and states reportedly spending as much as $68 million of their own funds, collectively, on abortion services in 2010 [2], the annual direct cost of UP remains high at an estimated $4.5 billion annually [1]. Furthermore, the total cost burden of UP to US taxpayers is reported to range from $9.6 to $12.6 billion per year [3]. Of those women who experience UP, historic survey data suggest that 50% were using contraception in the month of conception [4], and additional evidence suggests that the majority of UPs in women using contraception are due to incorrect or inconsistent use rather than method failure [1], [5].

Long-acting reversible contraceptive (LARC) methods are effective contraceptive methods [6], but they are often considered to be costly relative to short-acting reversible contraceptive (SARC) methods and have limited uptake in the United States [7]. Of women using reversible contraception in the United States, 55% use SARC methods, 27% use barrier methods (mainly condoms), 10% use natural methods such as withdrawal or periodic abstinence, while only 9% use LARC methods [7]. These various methods vary greatly in their effectiveness, duration of effect, level of required user adherence and overall cost [6]. Condoms are relatively inexpensive but rely heavily on correct and consistent use; SARC methods [oral contraception (OC), patch, ring and injections] require administration that ranges from daily to once every 3 months but are similarly dependent on regular user adherence [6]. In contrast, LARC methods [the copper intrauterine device (IUD), hormonal intrauterine systems (IUSs) and implant] require administration much less frequently (once every 3 to 10 years), and their effectiveness is not reliant upon user adherence [6].

While LARC use is associated with substantial upfront costs, there are no further year-on-year costs unless the method is prematurely discontinued, and they are associated with low method failure rates [6]. Previous publications indicate that LARC methods are cost-effective options relative to SARC methods [1], [8] and suggest that LARC methods become increasingly cost-saving with extended duration of use. This analysis aims to quantify the time point at which LARC methods achieve cost-neutrality relative to use of SARC methods, barrier methods (limited to condoms) and no method (chance). In doing so, the overall objective is to demonstrate that although LARC methods are not always used for their full duration of efficacy, cost-savings are realized even when LARC methods are used for a relatively short period of time.

Section snippets

Overview

A state transition model was developed to assess the total cost and effect of available contraceptive methods in the United States; the methods and results of this model are described in detail elsewhere [9]. The current analysis uses this model to estimate the annual costs associated with available LARC methods [levonorgestrel (LNG)-IUS) 20 mcg/24 h (total content 52 mg), implant and the copper IUD], SARC methods (generic OC, patch, ring and injections), condom and no method as the core

Base case analysis

The annualized costs per year, per method, per woman are summarized in Table 4. As expected, the average cost decreases for all methods as duration of use increases. Fig. 2 presents these data graphically and illustrates that despite high upfront costs associated with LARC methods, as duration of use increases, the average cost of LARC methods drops to become less expensive than the methods which have lower upfront costs.

The various points of intersection between the LARC methods and SARC,

Acknowledgment

This study and manuscript development were conducted by IMS Health and funded by Bayer Healthcare Pharmaceuticals Inc. This work was also supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant for Infrastructure for Population Research at Princeton University, Grant R24HD047879 (J.T.).

Anna Filonenko is a full-time employee of Bayer Pharma AG, and Amy Law is a full-time employee of Bayer Healthcare Pharmaceuticals Inc. Fareen Hassan and

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Funding: This study and manuscript development were funded by Bayer Healthcare Pharmaceuticals Inc. and supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant for Infrastructure for Population Research at Princeton University, grant R24HD047879 (J.T.).

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