Original research article| Volume 91, ISSUE 1, P49-56, January 2015

Achieving cost-neutrality with long-acting reversible contraceptive methods



      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.


      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.


      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.


      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.


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        • Trussell J.
        • Henry N.
        • Hassan F.
        • Prezioso A.
        • Law A.
        • Filonenko A.
        Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.
        Contraception. 2012; 87: 154-161
        • Sonfield A.
        • Gold R.B.
        Public funding for family planning, sterilization and abortion services, FY 1980–2010.
        Guttmacher Institute, New York2012 ([Available from:])
        • Monea E.
        • Thomas A.
        Unintended pregnancy and taxpayer spending.
        Perspect Sex Reprod Health. 2011; 43: 88-93
        • Finer L.B.
        • Darroch J.E.
        • Frost J.J.
        US agencies providing publicly funded contraceptive services in 1999.
        Perspect Sex Reprod Health. 2002; 34: 15-24
        • Moreau C.
        • Cleland K.
        • Trussell J.
        Contraceptive discontinuation attributed to method dissatisfaction in the United States.
        Contraception. 2007; 76: 267-272
        • Trussell J.
        Contraceptive failure in the United States.
        Contraception. 2011; 83: 397-404
        • Jones J.
        • Mosher W.
        • Daniels K.
        Current contraceptive use in the United States, 2006 -2010, and changes in patterns of use since 1995.
        in: National health statistics reports; no 60. National Center for Health Statistics, Hyattsville, MD2012
        • Mavranezouli I.
        The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline.
        Hum Reprod. 2008; 23: 1338-1345
        • Trussell J.
        • Hassan F.
        • Henry N.
        • Pocoski J.
        • Law A.
        • Filonenko A.
        Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 13.5 mg in contraception.
        Contraception. 2014; 89: 451-459
        • Trussell J.
        The cost of unintended pregnancy in the United States.
        Contraception. 2007; 75: 168-170
        • Mosher W.D.
        • Jones J.
        • Abma J.C.
        Intended and unintended births in the United States: 1982–2010.
        National health statistics reports. no. 55. National Center for Health Statistics, Hyattsville, MD2012
        • Vaughan B.
        • Trussell J.
        • Kost K.
        • Singh S.
        • Jones R.
        Discontinuation and resumption of contraceptive use: results from the 2002 National Survey of Family Growth.
        Contraception. 2008; 78: 271-283
        • Wolters Kluwer Health
        Medi-Span master drug database.
        (Available from:)
        • Centers for Medicare & Medicaid Services
        Medicare physician fee schedule, CPT code book and Medicare outpatient prospective payment system.
        (Available from)
        • HCUPnet
        Healthcare cost and utilization project.
        Agency for Healthcare Research and Quality, Rockville, MD2012 ([Available from:])
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare payment policy — section 2b physician services.
        (Available from)
        • Chiou C.F.
        • Trussell J.
        • Reyes E.
        • Knight K.
        • Wallace J.
        • Udani J.
        • et al.
        Economic analysis of contraceptives for women.
        Contraception. 2003; 68: 3-10
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • Petrosky E.
        • Madden T.
        • Eisenberg D.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105-1113
        • Ventura S.J.
        • Curtin S.C.
        • Abma J.C.
        • Henshaw S.K.
        Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008.
        in: National vital statistics reports; vol 60 no 7. National Center for Health Statistics, Hyattsville, MD2012
        • Hoover K.W.
        • Tao G.
        • Kent C.K.
        Trends in the diagnosis and treatment of ectopic pregnancy in the United States.
        Obstet Gynecol. 2010; 115: 495-502
        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspect Sex Reprod Health. 2006; 38: 90-96