Burden of unintended pregnancy in the United States: A role for increased use of long-acting reversible contraceptive methods

Objective: To evaluate the total costs of unintended pregnancy (UP) in the United States from a third-party healthcare payer perspective and to illustrate the potential role for long-acting reversible contraception (LARC) in reducing health care expenditure. Methods: An economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs which could be attributed to poor contraceptive adherence. Failure rates and health care resource costs were derived from the literature. Results: Direct medical costs of UP are $4.5 billion, and 53% of these may be attributed to poor contraceptive adherence. If 10% of women aged 20-29 switched from oral contraceptives to LARC, cost savings of > $200 million could be generated. Conclusions: LARC methods, which have higher levels of adherence than other forms of contraception, are an effective means of reducing unintended pregnancies and their associated cost burden. Improved access and uptake of LARC methods can generate health care savings, particularly in younger women who are most susceptible to adherence-related UPs.