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Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation

BACKGROUND: Tubal ligation remains common in the USA, especially among low-income patients. OBJECTIVE: To compare the effectiveness and safety of intrauterine contraceptives (IUC) to laparoscopic tubal ligation for Medicaid clients. DESIGN: We partnered with patient and clinician stakeholders to con...

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Autores principales: Schwarz, Eleanor Bimla, Lewis, Carrie A., Dove, Melanie S., Murphy, Eryn, Zuckerman, Diana, Nunez-Eddy, Claudia, Tancredi, Daniel J., McDonald-Mosley, Raegan, Sonalkar, Sarita, Hathaway, Mark, Gariepy, Aileen M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863411/
https://www.ncbi.nlm.nih.gov/pubmed/35194746
http://dx.doi.org/10.1007/s11606-022-07433-4
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author Schwarz, Eleanor Bimla
Lewis, Carrie A.
Dove, Melanie S.
Murphy, Eryn
Zuckerman, Diana
Nunez-Eddy, Claudia
Tancredi, Daniel J.
McDonald-Mosley, Raegan
Sonalkar, Sarita
Hathaway, Mark
Gariepy, Aileen M.
author_facet Schwarz, Eleanor Bimla
Lewis, Carrie A.
Dove, Melanie S.
Murphy, Eryn
Zuckerman, Diana
Nunez-Eddy, Claudia
Tancredi, Daniel J.
McDonald-Mosley, Raegan
Sonalkar, Sarita
Hathaway, Mark
Gariepy, Aileen M.
author_sort Schwarz, Eleanor Bimla
collection PubMed
description BACKGROUND: Tubal ligation remains common in the USA, especially among low-income patients. OBJECTIVE: To compare the effectiveness and safety of intrauterine contraceptives (IUC) to laparoscopic tubal ligation for Medicaid clients. DESIGN: We partnered with patient and clinician stakeholders to conduct a retrospective cohort study using California Medicaid claims for patients who had an IUC placed or laparoscopic tubal ligation performed in 2008–2014, excluding procedures performed within 42 days of a birth. We applied log-linear (Poisson) event-history regression models for clustered person-period data to adjust for sociodemographic variables and pre-procedure health status when examining associations between these contraceptive procedures and claims related to contraceptive failure, complications, and pain in the first year post-procedure. KEY RESULTS: We identified 35,705 patients who had a levonorgestrel IUC placed, 23,628 patients who had a copper IUC placed, and 23,965 patients who underwent laparoscopic tubal ligation. In unadjusted analyses, rates of pregnancy within 1 year were similar following levonorgestrel IUC (2.40%) or copper IUC placement (2.99%) or tubal ligation (2.64%). In adjusted analyses, compared to tubal ligation, pregnancy was less common following placement of a levonorgestrel IUC (adj IRR 0.72, 95% CI 0.64–0.82) and similar with placement of a copper IUC (adj IRR 0.92, 95% CI 0.82–1.05). Procedural complications such as infection (0.35% vs. 2.91%) were significantly less common with IUC placement than tubal ligation. Claims for pelvic and abdominal pain decreased in frequency with time since all procedures; 6 to 12 months post-procedure, pelvic pain claims were less common after levonorgestrel IUC (adj IRR 0.69, 95% CI 0.65–0.73) or copper IUC placement (adj IRR 0.70, 95% CI 0.66–0.75) than tubal ligation. CONCLUSIONS: IUC appears at least as effective as laparoscopic tubal ligation at 1-year post-procedure with lower rates of infection and pelvic pain 6 to 12 months post-procedure. CLINICAL TRIAL REGISTRATION: NCT03438682 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07433-4.
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spelling pubmed-88634112022-02-23 Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation Schwarz, Eleanor Bimla Lewis, Carrie A. Dove, Melanie S. Murphy, Eryn Zuckerman, Diana Nunez-Eddy, Claudia Tancredi, Daniel J. McDonald-Mosley, Raegan Sonalkar, Sarita Hathaway, Mark Gariepy, Aileen M. J Gen Intern Med Original Research BACKGROUND: Tubal ligation remains common in the USA, especially among low-income patients. OBJECTIVE: To compare the effectiveness and safety of intrauterine contraceptives (IUC) to laparoscopic tubal ligation for Medicaid clients. DESIGN: We partnered with patient and clinician stakeholders to conduct a retrospective cohort study using California Medicaid claims for patients who had an IUC placed or laparoscopic tubal ligation performed in 2008–2014, excluding procedures performed within 42 days of a birth. We applied log-linear (Poisson) event-history regression models for clustered person-period data to adjust for sociodemographic variables and pre-procedure health status when examining associations between these contraceptive procedures and claims related to contraceptive failure, complications, and pain in the first year post-procedure. KEY RESULTS: We identified 35,705 patients who had a levonorgestrel IUC placed, 23,628 patients who had a copper IUC placed, and 23,965 patients who underwent laparoscopic tubal ligation. In unadjusted analyses, rates of pregnancy within 1 year were similar following levonorgestrel IUC (2.40%) or copper IUC placement (2.99%) or tubal ligation (2.64%). In adjusted analyses, compared to tubal ligation, pregnancy was less common following placement of a levonorgestrel IUC (adj IRR 0.72, 95% CI 0.64–0.82) and similar with placement of a copper IUC (adj IRR 0.92, 95% CI 0.82–1.05). Procedural complications such as infection (0.35% vs. 2.91%) were significantly less common with IUC placement than tubal ligation. Claims for pelvic and abdominal pain decreased in frequency with time since all procedures; 6 to 12 months post-procedure, pelvic pain claims were less common after levonorgestrel IUC (adj IRR 0.69, 95% CI 0.65–0.73) or copper IUC placement (adj IRR 0.70, 95% CI 0.66–0.75) than tubal ligation. CONCLUSIONS: IUC appears at least as effective as laparoscopic tubal ligation at 1-year post-procedure with lower rates of infection and pelvic pain 6 to 12 months post-procedure. CLINICAL TRIAL REGISTRATION: NCT03438682 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07433-4. Springer International Publishing 2022-02-23 2022-12 /pmc/articles/PMC8863411/ /pubmed/35194746 http://dx.doi.org/10.1007/s11606-022-07433-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Research
Schwarz, Eleanor Bimla
Lewis, Carrie A.
Dove, Melanie S.
Murphy, Eryn
Zuckerman, Diana
Nunez-Eddy, Claudia
Tancredi, Daniel J.
McDonald-Mosley, Raegan
Sonalkar, Sarita
Hathaway, Mark
Gariepy, Aileen M.
Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title_full Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title_fullStr Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title_full_unstemmed Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title_short Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation
title_sort comparative effectiveness and safety of intrauterine contraception and tubal ligation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863411/
https://www.ncbi.nlm.nih.gov/pubmed/35194746
http://dx.doi.org/10.1007/s11606-022-07433-4
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