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Original research article| Volume 98, ISSUE 2, P120-124, August 2018

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Twelve-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg and subdermal etonogestrel implant in women aged 18–44: A retrospective claims database analysis

      Abstract

      Objective

      To investigate the 12-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg (LNG-IUS 13.5) and subdermal etonogestrel (ENG) implant in the US.

      Study Design

      We identified women aged 18–44 who had an insertion of LNG-IUS 13.5 or ENG implant from the MarketScan Commercial claims database (7/1/2013–9/30/2014). Women were required to have 12 months of continuous insurance coverage prior to the insertion (baseline) and at least 12-months after (follow-up). Discontinuation was defined as presence of an insurance claim for pregnancy-related services, hysterectomy, female sterilization, a claim for another contraceptive method, or removal of the index contraceptive without re-insertion within 30 days. Using Cox regression we examined the potential impact of ENG implant vs. LNG-IUS 13.5 on the likelihood for discontinuation after controlling for patient characteristics.

      Results

      A total of 3680 (mean age: 25.4 years) LNG-IUS 13.5 and 23,770 (mean age: 24.6 years) ENG implant users met the selection criteria. Prior to insertion, 56.6% of LNG-IUS 13.5 and 42.1% of ENG implant users had used contraceptives, with oral contraceptives being most common (LNG-IUS 13.5: 42.1%; ENG implant: 28.5%). Among users of LNG-IUS 13.5 and ENG implant, rates of discontinuation were similar during the 12-month follow-up (LNG-IUS 13.5: 24.9%; ENG implant: 24.0%). Regression results showed that women using LNG-IUS 13.5 vs. ENG implant had similar likelihood for discontinuation (hazard ratio: 0.97, 95% confidence interval: 0.90–1.05, p=.41).

      Conclusion

      In the real-world US setting, women aged 18–44 using LNG-IUS 13.5 and ENG implant have similar discontinuation rates after 12 months.

      Implications

      In the United States, women aged 18–44 using levonorgestrel intrauterine system (13.5 mg) and subdermal etonogestrel implant have similar discontinuation rates after 12 months.

      Keywords

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      References

        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374: 843-852
        • Curtis K.M.
        • Tepper N.K.
        • Jatlaoui T.C.
        • Berry-Bibee E.
        • Horton L.G.
        • Zapata L.B.
        • et al.
        U.S. medical eligibility criteria for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1-103
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        • Zapata L.B.
        • Horton L.G.
        • Jamieson D.J.
        • et al.
        U.S. selected practice recommendations for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1-66
        • American College of Obstetricians and Gynecologists
        ACOG Practice Bulletin No. 186 Summary: Long-acting reversible contraception: Implants and intrauterine devices.
        Obstet Gynecol. 2017; 130: 1173-1175
        • Berenson A.B.
        • Tan A.
        • Hirth J.M.
        Complications and continuation rates associated with 2 types of long-acting contraception.
        Am J Obstet Gynecol. 2015; 212: 761.e1-8
        • Rosenstock J.R.
        • Peipert J.F.
        • Madden T.
        • Zhao Q.
        • Secura G.M.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298-1305
        • Diedrich J.T.
        • Zhao Q.
        • Madden T.
        • Secura G.M.
        • Peipert J.F.
        Three-year continuation of reversible contraception.
        Am J Obstet Gynecol. 2015; 213: 662.e1-8
        • O'neil-Callahan
        • Peipert J.F.
        • Zhao Q.
        • Madden T.
        • Secura G.
        Twenty-four-month continuation of reversible contraception.
        Obstet Gynecol. 2013; 122: 1083-1091
      1. Highlights of Prescribing Information: SKYLA. Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ2016
      2. Highlights of Prescribing Information: Nexplanon. Merck & Co., Inc., Whitehouse Station, NJ2015
        • Nelson A.
        • Apter D.
        • Hauck B.
        • Schmelter T.
        • Rybowski S.
        • Rosen K.
        • et al.
        Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial.
        Obstet Gynecol. 2013; 122: 1205-1213
        • Gemzell-Danielsson K.
        • Schellschmidt I.
        • Apter D.
        A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena.
        Fertil Steril. 2012; 97: 616-622
        • Aiken A.R.A.
        • Trussel J.
        Recent advances in contraception.
        F1000Prime Rep. 2014; 6: 113
        • Gemzell-Danielsson K.
        • Apter D.
        • Hauck B.
        • Schmelter T.
        • Rybowski S.
        • Rosen K.
        • et al.
        The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose levonorgestrel intrauterine contraceptive systems: subgroup analyses of data from a phase III trial.
        PLoS One. 2015; 10: e0135309
        • Croxatto H.B.
        • Urbancsek J.
        • Massai R.
        • Coelingh Bennink H.
        • van Beek A.
        A multicentre efficacy and safety study of the single contraceptive implant Implanon®.
        Hum Reprod. 1999; 14: 976-981
        • Apter D.
        • Briggs P.
        • Tuppurainen M.
        • Grunert J.
        • Lukkari-Lax E.
        • Rybowski S.
        • et al.
        A 12-month multicenter, randomized study comparing the levonorgestrel intrauterine system with the etonogestrel subdermal implant.
        Fertil Steril. 2016; 106: 151-157
        • DeNoble A.E.
        • Hall K.
        • Xu X.
        • Zochowski M.K.
        • Piehl K.
        • Dalton V.K.
        Receipt of prescription contraception by commercially insured women with chronic medical conditions.
        Obstet Gynecol. 2014; 123: 1213-1220
        • Jones J.
        • Mosher W.D.
        • Daniels K.
        Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since.
        Natl Health Stat Report. 1995; 2012: 1-25
        • Daniels K.
        • Daugherty J.
        • Jones J.
        Current contraceptive status among women aged 15–44: United States, 2011–2013.
        NCHS Data Brief. 2014; : 1-8
        • Kavanaugh M.L.
        • Jerman J.
        • Finer L.B.
        Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012.
        Obstet Gynecol. 2015; 126: 917-927
        • Finer L.B.
        • Zolna M.R.
        Shifts in intended and unintended pregnancies in the United States, 2001–2008.
        Am J Public Health. 2014; 104: S43-S48