Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 13.5 mg in contraception

Abstract

Background-LNG-IUS 13.5mg (total content) is a low-dose levonorgestrel intrauterine system for up to three years of use. This analysis evaluated the cost-effectiveness of LNG-IUS 13.5mg in comparison with short-acting reversible contraceptive (SARC) methods in a cohort of young women in the US from a third-party payer's perspective.Study Design-A state-transition model consisting of three mutually exclusive health statesinitial method, unintended pregnancy (UP) and subsequent method -was developed. Costeffectiveness of LNG-IUS 13.5mg was assessed versus SARC methods in a cohort of 1,000 women aged 20-29 years. SARC methods comprise oral contraceptives (OC), ring, patch and injections which are the methods commonly used by this cohort. Failure and discontinuation probabilities were based on published literature, contraceptive uptake was determined by the most recent data from the National Survey of Family Growth and costs were taken from standard US databases. One-way sensitivity analysis was conducted around key inputs while scenario analysis assessed a comparison between LNG-IUS 13.5mg and the existing IUS, LNG-IUS 20mcg/24 hours. The key model output was cost per UP avoided.Results-Compared to SARC methods, initiating contraception with LNG-IUS 13.5mg resulted in fewer UP (64 UP vs. 276 UP) and lower total costs ($1,283,479 USD vs. $1,862,633 USD, a 31% saving) over the three-year time horizon. Results were most sensitive to the probability of failure on OC, the probability of LNG-IUS 13.5mg discontinuation and the cost of live births. Scenario analysis suggests that further cost savings may be generated with the initiation of LNG-IUS 20mcg/24 hours in place of SARC methods.* Corresponding author. Amy Law, Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ 07470, USA, Tel: +1 (973) 487-5855; amy.law@bayer.com. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-From a third-party payer perspective, LNG-IUS 13.5mg is a more cost-effective contraceptive option than SARC. Therefore, women switching from current SARC use to LNG-IUS 13.5mg are likely to generate cost savings to third-party healthcare payers, driven principally by decreased UP-related expenditures and long-term savings in contraceptive costs. NIH Public Access

Cost-effectiveness of emergency contraception options over 1 year

“…The model made the following assumptions: (1) pregnancy intentions remained stable over the 1-year time horizon; (2) women giving birth would not get pregnant again within 1 year; (3) women who discontinued contraception would not start again, except possibly after a pregnancy that did not result in a live birth 19,20 ; (4) in keeping with a previous cost-effectiveness analysis, women with an ectopic pregnancy were assumed not to be at risk for pregnancy for 2 menstrual cycles 21 ; (5) similarly, after a spontaneous or induced abortion women were assumed not to be at risk for pregnancy for 3 cycles 21 ; (6) effectiveness estimates and probability of discontinuation accounted for contraceptive adherence; (7) side effects of contraception resulted in negligible direct medical costs; and (8) the effectiveness of oral EC decreased as BMI increased. 4 …”

Achieving cost-neutrality with long-acting reversible contraceptive methods

“…A state transition model was developed to assess the total cost and effect of available contraceptive methods in the United States; the methods and results of this model are described in detail elsewhere [9]. The current analysis uses this model to estimate the annual costs associated with available LARC methods [levonorgestrel (LNG)-IUS) 20 mcg/24 h (total content 52 mg), implant and the copper IUD], SARC methods (generic OC, patch, ring and injections), condom and no method as the core contraceptive methods currently used by young women in the United States.…”

“…The model structure builds on a previously published study [9] and consists of three mutually exclusive states: (a) initial contraceptive method, (b) UP resulting from contraceptive failure and (c) subsequent contraceptive method. All women began in the initial contraceptive method state.…”

Jaydess®levonorgestrel intrauterine system

“…A study in the USA has suggested that women switching to the LNG-IUS 13.5 mg from a short-acting method may generate cost savings, principally via a decrease in costs associated with unplanned pregnancy expenditure, and that there may also be savings in terms of contraceptive costs in the long term 16. No cost-effectiveness comparisons were identified with Mirena or the potentially cheaper ‘hybrid’ LNG-IUS products that are being introduced for treatment of heavy menstrual bleeding and that might ultimately be licensed for contraception 17…”