Abstract
Objective
The objective was to assess changes in long-acting reversible contraceptive (LARC)
method uptake at Utah's Title X clinics before and after introduction of a new, low-cost
levonorgestrel (LNG) 52 mg IUD (Liletta®).
Study design
We conducted a retrospective medical record review of LARC visits occurring at seven
Title-X family planning clinics in Utah before the introduction of the low-cost LNG
IUD (preintroduction period: 01/01/2014–04/30/2015) and after (postintroduction period:
05/01/2015–03/31/2016). We ran segmented, interrupted time series ordinary least squares
regression models using Newey–West standard errors to assess both the change in numbers
of women initiating any LARC method and the average payment amount per LARC method.
We evaluated both the low-cost LNG IUD and all LARC methods.
Results
At the outset of preintroduction period, there were 29.2 [95% confidence interval
(CI): 20.1–38.4] monthly LNG IUD insertions. Immediately postintroduction, there was
a significant level of increase of 14.4 LNG IUD insertions the first month (95% CI:
2.0–26.8) followed by a significant trend increase each month of 2.4 additional LNG
IUD insertions (95% CI: 0.32–4.47). Postintroduction, there was a significant level
of remitted-payment decrease from all sources of −$240.43 per LNG IUD (95% CI: −311.02
to 168.87) followed by a significant monthly trend decrease of −$23.01 per LNG IUD
(95% CI: −32.02 to −13.98). There were minimal changes in uptake and payment of other
LARC methods following the introduction of the low-cost LNG IUD.
Conclusions
Following introduction of a low-cost LNG IUD at Title X clinics, LNG IUD initiation
increased and average payment for the method decreased.
Implications
Reducing the cost of LARC methods, both to clinics and to patients, is essential to
expanding access. Additional efforts to develop and provide access to low-cost copper
IUDs and subdermal implants as well as novel LARC methods should be continued.
Keywords
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Article info
Publication history
Published online: March 22, 2018
Accepted:
March 13,
2018
Received in revised form:
January 30,
2018
Received:
September 21,
2017
Footnotes
☆Initial findings were presented at the Society of Family Planning's annual North American Forum on Family Planning held in Denver, CO, November 2016.
☆☆The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.
★Conflict of interest: The Department of Obstetrics and Gynecology, University of Utah, receives contraceptive clinical trials research funding from Bayer, Bioceptive, Contramed, Medicines 360, Merck and Teva.
★★Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
☆☆☆J.N.S. and D.K.T. receive support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the Office of Research on Women's Health of the National Institute of Health under Awarded Number K12HD085852 and D.K.T. under K24HD087436.
Identification
Copyright
© 2018 Published by Elsevier Inc.
