Effectiveness of the etonogestrel implant: an economic model of immediate postpartum use on pregnancy outcomes.

OBJECTIVE

Long-acting reversible contraception (LARC) is the most effective form of reversible contraception. Leading organizations agree that LARC should be offered immediately postpartum. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This study evaluated whether the acquisition costs for the etonogestrel implant are offset via pregnancy prevention and pregnancy-related costs in the year after childbirth.

METHODS

A Markov model with 1-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptives for postpartum contraception: progestin-only oral contraception (OC), combined OC, progestin-only injectable, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. Time to postpartum initiation for each method and IUD expulsion rates were incorporated. Contraceptive acquisition costs, failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from Commercial and Medicaid payor perspectives. Sensitivity analyses were conducted.

RESULTS

The etonogestrel implant followed by IUDs were associated with the fewest short-interval pregnancies (8 [etonogestrel implant], 49 [3-year IUD], and 47 [≥5-year IUD], respectively) and the lowest Commercial (Medicaid) per-woman costs ($1,650 ($1,535) [etonogestrel implant]; $2,364 ($1,979) [3-year IUD]; and $2,519 ($2,145) [≥5-year IUD], respectively). In comparison, short-acting reversible contraception (SARC) resulted in 59-167 pregnancies, and Commercial (Medicaid) per-woman costs ranged from $2,244 ($1,749) to $5,102 ($4,106). Acquisition costs and discontinuation rates were the key drivers impacting overall costs.

CONCLUSIONS

The immediate postpartum provision of the etonogestrel implant produced the greatest cost savings due to fewer short-interval pregnancies and related expenditures. These results highlight the etonogestrel implant as a cost-effective option for clinicians seeking to reduce short-interval pregnancy and health system costs.