Long acting reversible contraceptives placed on same day could cut costs

By Dr. Ananya Mandal, MDSep 12 2019

Researchers from the Indiana University School of Medicine have studied the utility of making available a long acting reversible contraceptive for teenagers on the same day. They write that this small measure of making these contraceptives available on the same day could save the insurance providers a significant amount of money.

Contraceptive implant. Image Credit: Akkalak Aiempradit / Shutterstock

Their study titled, “Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents,” was published in the latest issue of the journal JAMA Network Open. Long acting reversible contraception (LAARC) for teenagers include Intrauterine devices or IUDs and implants.

Dr. Tracey A. Wilkinson, assistant professor of pediatrics, Dr. Stephen M. Downs, Jean and Jerry Bepko Professor of Pediatrics and Director of the Children's Health Services Research and General Pediatrics at IU School of Medicine and Dr. Brownsyne Tucker Edmonds Assistant Dean for Diversity Affairs and an Associate Professor of Obstetrics and Gynecology, IU School of Medicine, performed a cost minimization analysis. They looked at the availability of long-term reversible contraceptives to adolescents seeking birth control pills on the same day and its cost saving benefits. Their analysis looked at the costs this measure saved for the Medicaid. They wrote that in the United States 45 percent of all pregnancies are unwanted and these numbers need to be brought down. For adolescents, they wrote, the numbers were 85 percent. The team wrote, “These rates are significantly higher than those in other developed nations with similar resources and are associated with an estimated cost of $21 billion to the US government each year.”

Wilkinson explained that she was initially surprised that these methods of contraception were not made available to adolescents on the same day at the clinics. She said, “When I landed in Indiana, I quickly realized there were very few clinical sites providing same-day LARC. They are more expensive, but they are very effective, because they don't require any user dependence in order to work. As I started to piece together what the barriers were, one of the biggest seemed to be cost.” She added that this was the reason why they undertook this study.

The three researchers created a cost minimization model in order to determine the cost to the insurance company if an individual seeking birth control has to come back for a repeat visit. The three researchers were part of the Medicaid Medical Advisory Cabinet at IU School of Medicine. This team provides policy advice to Indiana's Office of Medicaid Policy and Planning. Thus the team decided to draw up details on cost savings to the insurance provider especially by reducing number of visits to the health care provider for birth control.

For this study the team first gathered data from previous studies and scenarios that showed and speculated the cost that the insurance company would incur if LARC was provided on the same day or if the adolescent or youngster seeking contraception came back for a second consultation or if the adolescents got pregnant and the cost to the insurance company for delivering a baby and cost of the yearly visits etc. Each of these scenarios was speculated and the costs predicted. Similarly, the benefits of providing these services were also analyzed to see if same day dispensing of LARC to cut down the costs.

Downs explained about the study design saying, “We thought about the typical young woman seeking contraception and drew a branching tree representing all of the things that might happen if she could or could not get it that day. The research literature tells us how likely all of those things are, and we know from medical claims how much they cost. With the resulting tree we can compare the average cost we'd expect if contraception is immediately available or not.”

Results revealed that if the same day LARC was given to the individual there was a lowering of costs. Same day dispensing of the LARC cost an average of $2,016 annually compared to $4,133 on average annually if a later visit was schedules, they wrote. Same day placement of the implant or IUD also reduced indirect costs that would result from unwanted pregnancies or abortions, the team wrote. They wrote,” Compared with the return-visit strategy, same-day LARC was associated with an unintended pregnancy rate of 14% vs 48% and an abortion rate of 4% vs 14%.”

Tucker Edmonds in a statement on the results of the study said, “We know that LARC is highly effective at preventing unintended pregnancy. Unintended pregnancy is associated with poor pregnancy outcomes, such as premature birth, which is a leading cause of infant mortality.” She added, “Seeing as unintended pregnancy, premature birth, and infant mortality disproportionately impact women and infants of color and low-income populations, it stands to reason that by improving access to same-day LARC, Medicaid could not only cut costs, but could potentially also improve health disparities related to prematurity and infant mortality.”

The authors concluded, “Providing same-day LARC could save costs for Medicaid, largely by preventing unintended pregnancy. Expected cost savings could be used to implement policies that make this strategy feasible in all clinical settings.”

The team wrote that the insurance providers such as Medicaid could provide incentives to clinicians who provide same day placement of LARC for adolescents. They added that this could reduce the costs of a two-day visit as well as long term indirect costs. They advise insurance providers to create a uniform reimbursement policy so that procedural delays are avoided for individual patients and the service could be provided on the same day to every presenting patient. This also meant that if an LARC device was ordered for a particular patient, it would be used on a presenting patient if left unused by the original patient it was meant for. To end the problem of shortage, bulk purchases and distribution of the LARC devices to the clinics could help improve same-day placement, the authors wrote.

Wilkinson concluded by saying, “Access matters, and any barrier to access means that fewer people will actually get to that finish line. When you have people, who desire contraception not being able to access it, the outcomes of all our communities are less than ideal. Planned pregnancies are healthier pregnancies, so having same-day access to all forms of contraception is vital.”