Two-year continuation of intrauterine devices and contraceptive implants in a mixed-payer setting: a retrospective review

Jessica N Sanders, David K Turok, Lori M Gawron, Amy Law, Lonnie Wen, Richard Lynen, Jessica N Sanders, David K Turok, Lori M Gawron, Amy Law, Lonnie Wen, Richard Lynen

Abstract

Background: As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined 2-year continuation rates for the levonorgestrel 52-mg intrauterine device, the copper T380A intrauterine device, and the 68-mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement.

Objective: The purpose of this study was to examine the proportion and characteristics of women who continue intrauterine device and implant use to 2 years and to relate continuation to device type when controlling for patient characteristics.

Study design: This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004, and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence risk ratios and to relate the probability of 2-year continuous use to device type.

Results: Data on 8603 device insertions were obtained with the following distribution: levonorgestrel 52-mg intrauterine devices (6459; 75.1%), copper T380A intrauterine devices (1136; 13.2%), and 68-mg etonogestrel implant (1008; 11.7%). Two-year continuation rates were 77.8%, 73.1%, and 75.9%, respectively. There was no statistical difference in 2-year continuation between levonorgestrel 52-mg intrauterine device users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) and 68-mg etonogestrel implant users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) compared with copper device users, after we controlled for age, Hispanic ethnicity, payer type, and year of insertion. Older-age, self-pay, or public payer insurance (reference commercial payer) and Hispanic ethnicity were associated with 2-year continuation.

Conclusion: Three-quarters of women with an intrauterine device or implant continue using it for 2 years. In this cohort, the 2-year continuation rates were 77.8%, 73.1%, and 75.9% for the levonorgestrel 52-mg intrauterine device, copper T380A intrauterine device, and 68-mg etonogestrel implant, respectively.

Keywords: continuation; contraceptive implant; healthcare system; intrauterine device.

Copyright © 2017. Published by Elsevier Inc.

Figures

FIGURE. Flowchart of study inclusion
FIGURE. Flowchart of study inclusion
Levonorgestrel 52mg IUD (LNG IUD); copper T380A IUD (Cu IUD); 68mg etonogestrel contraceptive implant (CI) Flowchart detailing the conditions discussed in this study. CI, 68-mg etonogestrel contraceptive implant; Cu IUD, copper T380A intrauterine device; IUD, intrauterine device; LNG IUD, levonorgestrel 52-mg intrauterine device; UUHS, University of Utah Healthcare System. Sanders et al. Two-year continuation of intrauterine devices and implants. Am J Obstet Gynecol 2017.

References

    1. Jones J, Mosher W, Daniels K. Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995. Natl Health Stat Report. 2012;60:1–25.
    1. Daniels K, Daugherty J, Jones J, Mosher W. Current contraceptive use and variation by selected characteristics among women aged 15–44: United States, 2011–2013. Natl Health Stat Report. 2015;86:1–14.
    1. Romero L, Pazol K, Warner L, et al. Vital signs: trends in use of long-acting reversible contraception among teens aged 15–19 years seeking contraceptive services — United States, 2005–2013. Morbidity and Mortality Weekly Report. 2015 Apr 10;64:363–9.
    1. Kavanaugh ML, Jerman J, Finer LB. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009–2012. Obstet Gynecol. 2015;126:917–27.
    1. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006;295:1809–23.
    1. Trussell J. Contraceptive efficacy. In: Hatcher R, Trussell J, Nelson A, Cates W, Kowal D, Policar M, editors. Contraceptive technology. 20. New York: Ardent Media; 2011. pp. 779–863.
    1. Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010;32:152–74.
    1. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol. 2012;120:1291–7.
    1. O’Neil-Callahan M, Peipert JF, Zhao Q, Madden T, Secura G. Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013;122:1083–91.
    1. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117:1105–13.
    1. Berenson AB, Tan A, Hirth JM, Wilkinson GS. Complications and continuation of intrauterine device use among commercially insured teenagers. Obstet Gynecol. 2013;121:951–8.
    1. Trussell J, Henry N, Hassan F, Prezioso A, Law A, Filonenko A. Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception. Contraception. 2013;87:154–61.
    1. Mavranezouli I, Group LGD. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod. 2008;23:1338–45.
    1. Trussell J, Hassan F, Lowin J, Law A, Filonenko A. Achieving cost-neutrality with long-acting reversible contraceptive methods. Contraception. 2015;91:49–56.
    1. Abraham M, Zhao Q, Peipert JF. Young age, nulliparity, and continuation of long-acting reversible contraceptive methods. Obstet Gynecol. 2015;126:823–9.
    1. Diedrich JT, Madden T, Zhao Q, Peipert JF. Long-term utilization and continuation of intrauterine devices. Am J Obstet Gynecol. 2015;213:822e1–6.
    1. Diedrich JT, Zhao Q, Madden T, Secura GM, Peipert JF. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015;213:662e1–8.
    1. Madden T, Mullersman JL, Omvig KJ, Secura GM, Peipert JF. Structured contraceptive counseling provided by the Contraceptive CHOICE Project. Contraception. 2013;88:243–9.
    1. Lyus R, Lohr P, Prager S. Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women. Contraception. 2010;81:367–71.
    1. Eisenberg DL, Schreiber CA, Turok DK, et al. Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system. Contraception. 2015;92:10–6.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅