Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents

IMPORTANCE: Long-acting reversible contraception (LARC) is considered first-line contraception for adolescents but often requires multiple clinic visits to obtain. OBJECTIVE: To analyze Indiana Medicaid’s cost savings associated with providing adolescents with same-day access to LARC. DESIGN, SETTING, AND PARTICIPANTS: An economic evaluation of cost minimization from the payer’s (Medicaid) perspective was performed from August 2017 through August 2018. The cost model examined the anticipated outcome of providing LARC at the first visit compared with requiring a second visit for placement. The costs and probabilities of clinic visits, devices, device insertions and removals, unintended pregnancy, and births, according to previously published sources, were incorporated into the model. The participants were payers (Medicaid). MAIN OUTCOMES AND MEASURES: The outcomes were the cost of same-day LARC placement vs LARC placement at a subsequent visit in US dollars, and rates of unintended pregnancy and abortion. One-way sensitivity analysis was done. RESULTS: Same-day LARC placement was associated with lower overall costs ($2016 per patient over 1 year) compared with LARC placement at a subsequent visit ($4133 per patient over 1 year). 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%. CONCLUSIONS AND RELEVANCE: 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.