Original research articleAchieving cost-neutrality with long-acting reversible contraceptive methods☆
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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2021, Epilepsy and BehaviorCitation Excerpt :The copper IUD was assumed to have an unplanned pregnancy rate of only 0.8 per 100 persons per year and an annualized cost of $174.66 [26,41]. This cost was calculated based on the device, insertion, removal, and monitoring costs ($1,362.37) that were annualized over 7.8 years of use, with the assumption that a 22% dropout rate in the first year of use would occur [28], and was adjusted to 2020 US dollars using the medical care component of the CPI [27]. The assumptions used in the model are listed below:
Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies
2021, Women's Health IssuesCitation Excerpt :However, developing a reimbursement process that includes networking between facilities, clinics, and health departments can be challenging for smaller hospital systems or facilities in rural areas (Palm et al., 2020), adding complexity to statewide policy use. Further complicating challenges of payment methodology implementation, in 2015, the upfront cost of a LARC device ranged from $598 to $703, depending on device type, and reimbursement of insertion procedures ranged from $71 to $135 (Trussell, Hassan, Lowin, Law, & Filonenko, 2015). In efforts to provide fuller access to immediate postpartum LARC, delivery facilities have developed alternate strategies to offset costs such as engaging in privately funded family planning residency programs to decrease costs for insertion procedures (Ryan Residency Program, 2021), or participating in the 340B Drug Pricing Program, a program intended to offset costs and increase availability of comprehensive services for eligible patients (Health Resources & Services Administration, 2020).
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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.).