Cost effectiveness of contraceptives in the United States

Abstract

Background: The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer's perspective.

Methods: A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates.

Results: Any contraceptive method is superior to "no method". The three least expensive methods were the copper-T intrauterine device (IUD) (US$647), vasectomy (US$713) and levonorgestrel (LNG)-20 intrauterine system (IUS) (US$930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy and plan disenrollment rates.

Conclusion: The copper-T IUD, vasectomy and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy and time horizon are influential factors that determine the overall value of a contraceptive method.

Fig. 1. Economic model structure

Note: the annualized cost at year x is the total cost for x years divided by x. The annualized costs for tubal ligation for year 1 and 2 (not shown in graph) were $2,912 and $1,470 respectively. The annualized cost for implant for year 1 was $1,477.

Fig. 2. Annualized costs associated with contraceptive methods

Note: The specific shaded area denotes which contraceptive method is more cost effective at a given cost of copper-T IUD and cost of LNG-20 IUS. (e.g., LNG-20 is more cost effective when the cost of LNG-20 IUS is less than $300 and the cost of copper-T IUD is more than $475). Costs in the graph denote the average wholesale price (AWP)-15% used in the model.

Fig. 3

Two-way sensitivity analysis on cost of LNG-20 IUS and copper-T IUD