A computer model predicts that offering women immediate postpartum etonogestrel implant insertion could be extremely cost-effective for both new mothers and medical insurance companies. The data is described in a study appearing in Obstetrics & Gynecology.
Researchers from the Yale University School of Medicine and the University of California, Irvine developed a decision-analytic model to determine a hypothetical population of 1,000 women who request a contraceptive implant following a recent birth. The cost-effectiveness of immediate (before discharge from the childbirth hospital stay) vs. delayed (6–8 weeks) postpartum etonogestrel implant insertion was computed based on the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented.
Immediate postpartum implant insertion was associated with a greater expected cost compared to delayed insertion ($1,091/patient vs. $650/patient, respectively), but was more effective in preventing pregnancies (expected pregnancy rate 2.4% and 21.6%, respectively). The incremental cost-effectiveness ratio was calculated at $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient.
Lead author Aileen Gariepy, MD, added that although this immediate postpartum period is an ideal time for initiating contraceptives, most insurance policies do not provide coverage for this while the mother is still in the hospital. She also noted that changes to this policy could have significant public health and financial benefits.
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