Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?

• Published in: American journal of obstetrics and gynecology 2014-07, Vol.211 (1), p.24.e1-24.e7
• Main Authors: Han, Leo, MD, Teal, Stephanie B., MD, MPH, Sheeder, Jeanelle, MSPH, PhD, Tocce, Kristina, MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Colorado; Contraceptive Agents, Female - economics; cost; Cost-Benefit Analysis; Desogestrel - economics; Female; Follow-Up Studies; Health Care Costs - statistics & numerical data; Humans; immediate contraception; implant; Intrauterine Devices, Medicated - economics; long-acting reversible contraception; Medicaid; Obstetrics and Gynecology; Parity; Postnatal Care - economics; Postnatal Care - methods; postpartum; Pregnancy; Pregnancy in Adolescence - prevention & control; Prenatal Care - economics; Prenatal Care - methods; Prospective Studies; United States; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.03.015

Objective The objective of the study was to determine the cost-effectiveness of a hypothetical state-funded program offering immediate postpartum implant (IPI) insertion for adolescent mothers. Study Design Participants in an adolescent prenatal-postnatal program were enrolled in a prospective observational study of IPI insertion (IPI group, n = 171) vs standard contraceptive initiation (comparison group, n = 225). Implant discontinuation, repeat pregnancies and pregnancy outcomes were determined. We compared the anticipated public expenditures for IPI recipients and comparisons at 6, 12, 24, and 36 months postpartum using the actual outcomes of this cohort and Colorado Medicaid reimbursement estimates. Costs were normalized to 1000 adolescents in each arm and included 1 year of well-baby care for delivered pregnancies. Results At 6 months, the expenditures of the IPI group exceed the comparison group by $73,000. However, at 12, 24, and 36 months, publicly funded IPIs would result in a savings of more than $550,000, $2.5 million, and $4.5 million, respectively. For every dollar spent on the IPI program, $0.79, $3.54, and $6.50 would be saved at 12, 24, and 36 months. Expenditures between the IPI and comparison groups would be equal if the comparison group pregnancy rate was 13.8%, 18.6%, and 30.5% at 12, 24, and 36 months. Actual rates were 20.1%, 46.5%, and 83.7%. Conclusion Offering IPIs to adolescent mothers is cost effective. Payors that do not currently cover IPI should integrate these data into policy considerations.