Supplying Same-Day Long-Acting Reversible Contraception Associated With Major Cost Savings, Study Shows

Providing adolescents seeking birth control with the ability to receive long-acting reversible contraceptive (LARC) on the same day as their clinic visit is linked with potentially significant cost savings for insurance providers, according to a study published this week in the journal JAMA Network Open.

Indiana University School of Medicine study authors Tracey A. Wilkinson, MD, assistant professor of pediatrics; Brownsyne Tucker Edmonds, MD, associate professor of obstetrics and gynecology; and Stephen M. Downs, vice chair of general pediatrics, evaluated Indiana’s potential Medicaid cost savings attributed to providing same-day access of LARC to adolescents.

Cost is an underlying barrier to entry for adolescents seeking LARC. As Wilkinson highlighted in a statement, “I quickly realized there were 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."

While considered the most effective contraception for adolescents, LARC normally requires multiple clinic visits, which contributes to costs and heightened probabilities related to device insertions and removals, unintended pregnancy, and births. Researchers created a cost minimization model to determine the economic cost to Medicaid for variables such as additional visits, the device, and the cost of delivering a baby.

“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,” said Downs.

Costs were compared based on distinction of same-day LARC and return-visit strategy for LARC placement after subsequent visits. Correlated rates of unintended pregnancy and abortion were additionally determined:

• Same-day LARC placement resulted in $2016 per patient over 1 year
• LARC placement at a subsequent visit resulted in $4133 per patient over 1 year
• Same-day LARC had a 14% chance of unintended pregnancy, and 4% chance of abortion
• Return-visit strategy for LARC had a 48% chance of unintended pregnancy, and 14% chance of abortion

The substantial decrease in costs associated with administering LARC on the same day stresses its potential regardless of its expensive implementation. As 85% of all adolescent pregnancies in the United States are unintended, same-day LARC can significantly cut these probabilities and subsequent costs for Medicaid. Improving health disparities in minority and low-income women and infants of color, who are disproportionately affected by infant prematurity and mortality, was further emphasized by Edmonds.

The researchers provided 4 recommendations to state Medicaid officials to enhance same-day LARC distribution based on their findings:

• Provide bonus payments for clinicians to incentivize same-day contraceptive access
• Create a single, uniform reimbursement structure, preferably as a medical benefit, to mitigate procedural delays related to having as opposed to ordering and waiting for devices
• Pursue a strategy to purchase LARC devices in bulk and distribute devices up front to clinics desiring to provide same-day access
• Develop a policy whereby LARC devices that were ordered for a specific patient but ultimately unused after a certain time could be used for another patient instead of ordering a new device and returning the unused device

“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 are healthier pregnancies, so having same-day access to all forms of contraception is vital,” said Wilkinson.

Reference

Wilkinson TA, Downs SM, Edmonds BT. Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents. [published online September 11, 2019]. JAMA Network Open. doi: 10.1001/jamanetworkopen.2019.11063.