Continuation of long-acting reversible contraceptives among Medicaid patients

Max J Romano; Patryce Toye; Loral Patchen

doi:10.1016/j.contraception.2018.04.012

Continuation of long-acting reversible contraceptives among Medicaid patients

Contraception. 2018 Apr 24:S0010-7824(18)30148-3. doi: 10.1016/j.contraception.2018.04.012. Online ahead of print.

Authors

Max J Romano¹, Patryce Toye², Loral Patchen³

Affiliations

¹ MedStar Franklin Square Medical Center Department of Family Medicine, 9101 Franklin Square Dr. Baltimore, MD 21237; Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, 615 N. Wolfe St. Room WB602, Baltimore, MD 21205-1996. Electronic address: Mromano4@jhu.edu.
² MedStar Family Choice, 5233 King Ave, Ste. 400, Rosedale, MD 21237.
³ MedStar Health Research Institute, 110 Irving St. NW Suite EB-7113, Washington, DC 20010; MedStar Washington Hospital Center, 110 Irving St. NW Suite EB-7113, Washington, DC 20010.

PMID: 29702080
DOI: 10.1016/j.contraception.2018.04.012

Abstract

Objective: Our objective was to compare continuation and complication rates of subdermal etonogestrel implants and intrauterine devices (IUDs) using Medicaid insurance claims.

Study design: We performed a retrospective cohort study using insurance claims data for 15- to 44-year-old subjects receiving implants or IUDs from 2012 to 2015 in a Medicaid managed care organization in Washington, DC, and Maryland. We performed a planned Kaplan-Meier survival analysis for long-acting reversible contraceptive (LARC) continuation, defined as the absence of a claim for LARC removal, during periods of continuous insurance plan enrollment.

Results: Three thousand one hundred three subjects received 1335 implants and 1970 IUDs, with implants more common than IUDs among subjects 15-19 years old (rate ratio=2.42), and implants less common than IUDs for subjects 20-44 years old (rate ratio=0.54). Implants had higher continuation rates at 1 year than IUDs (81.0% vs. 76.7%, p=.01). The difference was larger among subjects 25 to 44 years old (84.1% vs. 79.3%, p=.03) compared with subjects 15 to 19 years old (89.5% vs. 86.8%, p=.09) and subjects 20 to 24 years old (75.7% vs. 73.2%, p=.44). Claims for potential complications were similarly uncommon for both implants and IUDs (8.09% vs. 6.95%, p=.65), as were claims for pregnancies prior to LARC removal (0.82% vs. 0.86%, p=.86).

Conclusion: Among a sample of 15- to 44-year-old Medicaid recipients, both implants and IUDs had high continuation rates and low complication rates; however, implants were slightly more likely than IUDs to remain in use 1 year after insertion.

Implications: Among 15- to 44-year-old Medicaid recipients, both etonogestrel implants and IUDs have high continuation rates and low complication rates at 1-year postinsertion; however, implants are slightly more likely than IUDs to remain in use at 1 year.

Keywords: Etonogestrel implant; Intrauterine device; Long-acting reversible contraception; Medicaid; Survival analysis.