Switching from Oral to Intrauterine Contraception May Result in Cost Savings for Health Plans

San Diego—Switching oral contraceptive (OC) users to a low-dose levonorgestrel-intrauterine (LNG-IUS) system may result in overall cost savings for healthcare plans, due to subsequent decreases in pharmacy costs and a decrease in medical costs related to unintended pregnancies, according to information presented during a poster session at the AMCP meeting. The poster was titled Budget Impact of the Introduction of a Low-Dose Levonorgestrel-Intrauterine System from a US Third-Party Payer Perspective.

Coverage decisions for contraceptives necessitate the consideration of costs related to pregnancy outcomes and to contraceptive products over the duration of their use. A recent study estimated the budget impact to a US healthcare plan after switching women from OCs to a 3-year LNG-IUS (13.5 mg).

The researchers conducted 2 analyses: (1) a base-case analysis where no discontinuation was considered; and (2) a second-case analysis in which 20% of LNG-IUS users discontinued after 1 year and switched back to OCs.

Data sources such as the U.S. Census Bureau and National Survey of Family Growth were used to determine the number of women using or requiring contraception. The Medi-Span^® Master Drug Database was used to determine unit costs of contraceptive methods.

Using a budget impact model, the researchers estimated costs before and after the availability of LNG-IUS 13.5 mg, over a 3-year time period, among women between 15 and 44 years of age at risk of an unintended pregnancy, and who were covered by a health plan. The model included direct costs for contraceptives and associated physician visits as well as pregnancy outcomes resulting from method failures. Estimated costs were based on product and medical costs associated with initiation and follow-up of the contraceptive method.

Among a cohort of 1 million plan members, results of the base-case analysis estimated a reduction of $516,166 in total costs and $0.04 in per-member-per-month (PMPM) costs. In the second-case analysis, results showed discontinuation of LNG-IUS after the first year led to a decrease in total costs of $381,032 and PMPM costs of $0.03. Results also showed an estimated decrease in unintended pregnancies of 153 in the base-case analysis and 134 in the second-case analysis.

Based on sensitivity analyses of the model, the projected savings are likely to vary with the proportion of women on LNG-IUS, the units of OCs used per year, and the failure rates of no method and OCs. Another limitation of the study is that it was based on multiple assumptions and cannot take into account all influences. Actual experience would likely differ from these projections for reasons that include random fluctuation.

This study was supported by Bayer HealthCare Pharmaceuticals.