(129) Cost Consequence Analysis of Hormonal Contraception in the United States

Background: : The unmet need and burden associated with unplanned pregnancies is substantial. Reducing the frequency of unplanned pregnancy is therefore one of the most important reproductive health goals set forth by leading health organizations worldwide. Access to effective contraception is fundamental in achieving this goal.

Objective: : A model was developed to assess if acquisition costs for the etonogestrel implant (implant) and intrauterine devices (IUDs), which are the most effective forms of reversible contraception, are offset via pregnancy prevention and pregnancy-related costs.

Methods: : A Markov model with 5-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined OC), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a United States managed care perspective. Sensitivity analyses were conducted.

Results: : Over 5 years, the implant and IUDs were associated with the fewest pregnancies (60 [implant], 105 [3-year IUD], and 104 [≥5-year IUD], respectively) and the lowest costs per-woman ($3,428 [implant], $5,275 [3-year IUD], and $4,728 [≥5-year IUD], respectively). Cost offsets occurred in Year 1 and increased incrementally through Year 5. In comparison, branded and generic OCs had 299 and 323 pregnancies, respectively, and $8,477 and $8,678 in costs per-woman; the vaginal ring, injection, and patch had 328, 265, and 327 pregnancies, respectively, with costs per-woman ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs.

Conclusions: : The implant and IUDs produced the greatest cost savings due to the lower number of pregnancies and associated costs.

Sponsorship:: Organon & Co.