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.
Keywords
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Article info
Publication history
Published online: September 06, 2014
Accepted:
August 31,
2014
Received in revised form:
August 22,
2014
Received:
November 8,
2013
Footnotes
☆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.).
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
