Cost benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States

Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA.
Contraception (Impact Factor: 2.93). 04/2010; 81(4):304-8. DOI: 10.1016/j.contraception.2009.11.002
Source: PubMed

ABSTRACT To examine the hospital and state costs of offering the option of a postpartum intrauterine device (IUD) to an underinsured population of recent immigrants to the United States with Emergency Medicaid (EM) insurance coverage only.
This study is a retrospective cohort study comparing the costs of offering a reversible long-acting method of contraception (IUD) postpartum to women with EM and the current policy of covering the obstetrical delivery only. A cost-benefit analysis from the perspective of both the hospital and the state was conducted. A database of EM obstetrical patients from 2002 to 2006 was created from hospital billing records to calculate mean pregnancy costs and revenue, as well as the probability of repeat pregnancy and pregnancy outcome. Probability of IUD uptake and continuation was obtained from hospital records and the literature.
A postpartum IUD program is not cost beneficial from the hospital's perspective, losing 70 cents per dollar spent on the program. However, the state government would save $2.94 for every dollar spent on a state-financed IUD program.
Considering only the direct costs associated with a repeat pregnancy, a program offering the option of postpartum IUD placement to underinsured women would significantly reduce state expenditures on subsequent pregnancies.


Available from: Maria Isabel Rodriguez, Jun 04, 2014
  • Contraception 04/2014; 89(6). DOI:10.1016/j.contraception.2014.04.013 · 2.93 Impact Factor
  • Contraception 08/2014; 90(5). DOI:10.1016/j.contraception.2014.08.005 · 2.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine 3-year continuation rates of the etonogestrel contraceptive implant when inserted immediately postpartum, and to identify factors associated with discontinuation. Study Design A retrospective cohort of 262 women who had the contraceptive implant inserted immediately postpartum between January 2008 and March 2009 was collected from electronic medical records. Continuation rates at one, two, and three years were estimated. Adverse effects leading to removal of the implant were recorded. Multivariable Cox proportional hazards models were performed to determine factors associated with early discontinuation. Results Large subsets of the study patients were adolescent (28.2%), multigravid (71.8%), and presented for fewer than 6 prenatal visits (38.5%). Follow-up rates were over 70% at each of the three years. Adolescents and women with fewer than 6 prenatal visits had the highest continuation rates at one year, 94.5% and 94.1%, respectively. The cumulative implant continuation rate after 3 years was 66.3%. Multivariable analysis indicated that having 6 or more prenatal care visits was the only independent predictor of early discontinuation, with a hazard ratio of 3.1 (p = 0.04) and 1.8 (p = < 0.01) at one and three years, respectively. The most commonly reported reasons for early removal were abnormal bleeding (41.2%) and weight gain (19.1%). Conclusion The contraceptive implant has high continuation over its three-year lifespan when inserted immediately postpartum. Continuation rates were highest among populations most vulnerable to rapid repeat and unintended pregnancies. Implications The etonogestrel implant, when placed immediately postpartum for contraception, can have high continuation rates of use for up to three years duration.
    Contraception 09/2014; 90(3). DOI:10.1016/j.contraception.2014.05.006 · 2.93 Impact Factor