Cost-benefit analysis of a Medicaid-funded long acting reversible contraception (LARC) promotion program in Rhode Island

BACKGROUND: In 2008, 41.4% of pregnancies in Rhode Island were unintended, of which 59% were publicly funded, costing the state $31 million. Unintended pregnancies are associated with poorer neonatal and maternal health outcomes and are strongly correlated with imperfect contraception adherence. Long-acting reversible contraceptive (LARC) methods, namely intra-uterine devices, have the lowest failure rates of any method but are utilized by less than 2% of women in Rhode Island.

OBJECTIVE: Evaluate cost savings for Rhode Island Medicaid (RIte Care) generated by reducing unintended pregnancies through promotion of LARC and coverage of out-of-pocket expenditures on LARC for enrolled women aged 15-44.

METHODS: We propose a LARC promotion program that 1) trains providers at family planning clinics to counsel patients about LARC and 2) provides LARC to women free of charge. Drawing upon a previous national study and conversations with the Rhode Island Department of Health, we model three hypothetical program scenarios in which a small proportion (5-10%) of women using either short-acting reversible contraception (SARC) or no contraception switch to LARC over three years. The net benefit is calculated by combining costs of providing contraception with savings from reductions in unintended pregnancies.

FINDINGS: A program in which 5% of women using SARC and 5% of women using no method switch to LARC over the course of three years results in net savings of $966,000 for RIte Care.

CONCLUSIONS: If implemented, an intervention promoting LARC uptake by RIte-Care enrolled women would be a cost-effective and high-impact way to reduce unintended pregnancies.