Comparative cost-effectiveness of reversible family planning methods following emergency contraception use in the Medicaid population

Background: Regular contraceptive use should be recommended for women receiving emergency contraception (EC). Ease of use of longer term contraceptives, as well as effectiveness in the presence of less-than-perfect adherence, may be important decision parameters for this population. Objectives: To evaluate cost-effectiveness of long-term, reversible contraceptive use in a population of young (<25 years old) women using EC, from the public payer (Medicaid) perspective over a 5-year period. Methods: A hybrid decision tree-Markov model was designed to evaluate economic and epidemiologic outcomes associated with use of various contraceptive methods. Discontinuation rates, method-switch patterns, method-specific failure probabilities, pregnancy outcome probabilities, and costs of methods, office visits, and pregnancy were incorporated into the model. The main outcome of interest was incremental cost per pregnancy averted in 2007 US$. Economic and epidemiologic inputs to the model were informed by detailed searches of primary, peer-reviewed contraceptive literature. Results: IUD/IUS was the most cost-effective method. IUD/IUS was cost-saving in head-to-head comparisons with oral contraception, injected contraception, and no medical contraception in 100% of 1000 Monte Carlo trials, and dominated hormonal implants in 21.3% of 1000 trials. Both injected contraception and hormonal implants were cost-effective over oral contraception ($1,592/pregnancy averted and $517/pregnancy averted, respectively). Generally, using any method of medical contraception was cost-effective compared to using no medical contraception. Conclusion: Modern birth control methods were widely cost-effective for this population. Method-specific frequency of and costs related to side effects and patient preferences for particular methods may be important parameters to explore in future models.