A DECISION MODEL TO ESTIMATE UNINTENDED PREGNANCIES AVERTED AND COST SAVINGS FROM THE PROVISION OF FREE LONG-ACTING REVERSIBLE CONTRACEPTIVES

Purpose:  To estimate unintended pregnancies, pregnancy outcomes, and costs averted from an initiative that provided free long-acting reversible contraceptives (LARC) to low-income women who obtained services in Title X-funded clinics in Colorado.  

Methods:  We developed a recursive decision analytic model to compare the probability of unintended pregnancy, miscarriage, abortion, and births as well as the costs associated with two scenarios. In one scenario, we modeled outcomes using data from the Colorado Family Planning Initiative (CFPI), which provided LARCs at no cost in Title-X funded family planning clinics starting in 2009. In the counterfactual scenario, we modeled outcomes assuming that women would have used the same contraceptive mix as before the CPFI. Inputs for the model are contraceptive failure rates for typical use obtained from a review of the literature; the actual mix of contraceptives used, before and after the initiative, at Title X-funded clinics in Colorado; and the probability of pregnancy outcomes (delivery, miscarriage, abortion). We obtained direct medical costs from publicly available data. Analyses were stratified by age group: 15-19 and 20-24. We use a one-year cycle and modeled outcomes from 2009 to 2014.

Results:  The CFPI significantly increased the use of LARCs, from approximately 8% in 2009 to over 26% in 2014. Most of the increase was the result of women switching from short-acting hormonal oral contraceptives (pills). Our model shows that the initiative reduced unintended pregnancies and other outcomes by approximately 17%, for age group 15-19, and 7.8%, for age group 20-24, from 2009 to 2014. A comparison of the cost of the initiative to the costs averted shows that the initiative was cost saving.     

Conclusions:  LARCs are extremely effective with failure rates of less than one percent, which, importantly, do not depend on appropriate use of the method. A known barrier to LARC use is the high cost of the devices. By providing LARCs at no cost, the CFPI greatly reduced unintended pregnancies and associated pregnancy outcomes. Programs that increase the use of LARCs among young, low-income women have great potential to reduce unintended pregnancies and produce cost savings.