Original research articleBurden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception☆
Introduction
Despite intense focus on reducing unintended pregnancies (UPs) in the United States (US) in recent years, nearly half (49%) of all pregnancies are unintended [1]. UPs are associated with adverse consequences for both mother and child [2] and with a high rate of abortion [3], [4]. Total costs to US taxpayers from UP have been estimated to range from $9.6 to $12.6 billion a year [5], whilst annual direct medical costs have been estimated to be $5 billion [6]. These costs are theoretically avoidable.
Available methods of contraception are effective when adherence is high [7], [8], [9], but during real-world usage, imperfect adherence contributes to contraceptive failure, with an estimated 48% of all UPs in the United States occurring in women who are using contraception [4]. Long-acting reversible contraception (LARC), which includes implants and intrauterine contraceptives, is the most effective type of reversible contraception [8] because adherence is not required. In this analysis, an economic model was used to estimate the cost to third-party payers associated with UP and to estimate the proportion of this cost attributable to imperfect contraceptive adherence. The model also estimated cost savings that might be generated by women switching to LARC from other contraceptive methods.
Section snippets
Model design and population
A cost model was constructed as follows: first, the annual number of UP-related events and the associated cost were estimated; next, utilization and cost of contraceptive methods in the United States were evaluated, and the proportion of UP events in the United States associated with imperfect adherence was estimated; finally, the change in UP and the cost impact that might result from increased use of LARC were derived. The framework follows the structure of an earlier analysis [6].
The model
UP-related events and costs
The estimated annual number of UPs is 3.11 million, resulting in 1.44 million live births, 1.11 million induced abortions, 539,000 spontaneous abortions and 19,000 ectopic pregnancies. Over half (53%) of UPs in the United States occurred in women 20–29 years of age (Table 1).
The weighted average cost for each UP in the US outcome is shown in Table 2. The estimated annual cost of UP outcomes is $4.6 billion.
Contraceptive costs and effectiveness
Annual contraceptive costs ranged from $22 for condoms to more than $1000 for the patch (
Discussion
The total direct medical cost of UP was estimated to be greater than $4.6 billion annually, consistent with previous estimates [6]. Our results suggest that greater than half of UP costs in the US may be attributed to imperfect contraceptive adherence, with a particularly high cost in women aged under 35 years. Our analysis also indicates that significant cost savings may be generated among women aged 20–29 years by switching from SARC to LARC.
There are several limitations to the analysis. Only
Acknowledgment
IMS Health, funded by Bayer Healthcare Pharmaceuticals Inc., developed the model based on input from the authors.
The authors wish to acknowledge Katherine Coyle (IMS Health, Alexandria, VA, USA) for her assistance in the preparation of this manuscript as well as Adam Lloyd, M.A., M.Phil.; Julia Lowin, M.Sc. (IMS Health, London, UK); and Dr. Kerstin Uhl-Hochgraeber (Berlin, Germany) for their valuable input.
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Anna Filonenko is a full-time employee of Bayer Pharma AG. Amy Law and Alexander Prezioso are full-time employees of Bayer Healthcare Pharmaceuticals Inc. Nathaniel Henry and Fareen Hassan are full-time employees of IMS Health and served as paid consultants to Bayer Healthcare Pharmaceuticals Inc. for the development of this study and manuscript. James Trussell is a full-time professor of economics and public affairs at Princeton University and received a consultancy fee from Bayer Pharma AG for his contribution to this work.