Cost–benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States

Rodriguez, Maria Isabel; Caughey, Aaron B.; Edelman, Alison; Darney, Philip D.; Foster, Diana Greene

doi:10.1016/j.contraception.2009.11.002

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Volume 81, Issue 4 , Pages 304-308, April 2010

Cost–benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States☆

Maria Isabel Rodriguez
- Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
- Corresponding author. San Francisco General Hospital, San Francisco, CA 94110, USA. Tel.: +1 415 206 8358; fax: +1 415 206 3112.
Aaron B. Caughey
- Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
Alison Edelman
- Department of Obstetrics AND Gynecology, Oregon Health and Science University, Portland, OR 97239, USA
Philip D. Darney
- Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA 94110, USA
Diana Greene Foster
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA 94110, USA

Received 27 August 2009; received in revised form 27 October 2009; accepted 5 November 2009. published online 07 December 2009.

Abstract

Objective

To examine the hospital and state costs of offering the option of a postpartum intrauterine device (IUD) to an underinsured population of recent immigrants to the United States with Emergency Medicaid (EM) insurance coverage only.

Study Design

This study is a retrospective cohort study comparing the costs of offering a reversible long-acting method of contraception (IUD) postpartum to women with EM and the current policy of covering the obstetrical delivery only. A cost–benefit analysis from the perspective of both the hospital and the state was conducted. A database of EM obstetrical patients from 2002 to 2006 was created from hospital billing records to calculate mean pregnancy costs and revenue, as well as the probability of repeat pregnancy and pregnancy outcome. Probability of IUD uptake and continuation was obtained from hospital records and the literature.

Results

A postpartum IUD program is not cost beneficial from the hospital's perspective, losing 70 cents per dollar spent on the program. However, the state government would save $2.94 for every dollar spent on a state-financed IUD program.

Conclusion

Considering only the direct costs associated with a repeat pregnancy, a program offering the option of postpartum IUD placement to underinsured women would significantly reduce state expenditures on subsequent pregnancies.

Keywords: Cost–benefit analysis, Postpartum intrauterine contraception, Immigrants, Emergency Medicaid