Nav: Home

Study shows cost savings from same-day long-acting reversible contraception

September 11, 2019

INDIANAPOLIS, September 11, 2019--According to a new study by Indiana University School of Medicine doctors, providing adolescents seeking birth control the ability to obtain a long-acting reversible contraceptive on the same day as their clinic visit could lead to significant cost savings for insurance providers.

Published today in the journal JAMA Network Open, the study was the work of three IU School of Medicine faculty--Tracey A. Wilkinson, MD, MPH, Stephen M. Downs, MD, MS, and Brownsyne Tucker Edmonds, MD, MPH, MS.

In the study, the researchers worked to determine what the cost savings would be by providing same-day access to long-acting reversible contraception, from the perspective of insurance companies, in particular, Medicaid, to adolescents. Considered the most effective contraception for adolescents, long-acting reversible contraception, or LARC, include intrauterine contraceptives (IUCs) and implants.

According to Wilkinson, who joined the faculty at IU School of Medicine four years ago, the lack of clinics in Indiana offering same-day access to these contraceptives came as a surprise when she began her work in the state as a health services researcher.

"When I landed in Indiana, I quickly realized there were very few clinical sites providing same-day LARC. They are more expensive, but they are very effective, because they don't require any user dependence in order to work," Wilkinson said. "As I started to piece together what the barriers were, one of the biggest seemed to be cost."

Teaming with Downs and Tucker Edmonds, Wilkinson said the group set out to create a cost minimization model to determine the cost to an insurance company when a patient is required to come back to the clinic for subsequent visits to receive their desired contraceptive.

Drawing on their work as members of the Medicaid Medical Advisory Cabinet at IU School of Medicine--a group of physicians who provide research-based policy advice to Indiana's Office of Medicaid Policy and Planning--Downs and Tucker Edmonds joined Wilkinson in compiling data that would help them come up with a policy that could show a cost savings to Medicaid.

Using data from previous studies, the group worked through all of the scenarios that could result from an adolescent seeking same-day LARC. With each step, the group calculated what the cost would be to the payer--looking into the cost of the device, the cost of delivering a baby, the cost of an annual visit, and so on.

"We thought about the typical young woman seeking contraception and drew a branching tree representing all of the things that might happen if she could or could not get it that day," Downs said. "The research literature tells us how likely all of those things are, and we know from medical claims how much they cost. With the resulting tree we can compare the average cost we'd expect if contraception is immediately available or not."

Through their work, the group found that same-day LARC placement led to overall lower costs to the payer--$2,016 on average--compared with placement at a later visit--$4,133 on average. Additionally, they found that the numbers of unintended pregnancies and abortions decreased in association with providing same-day placement.

A cost-saver for the insurance companies and Medicaid, Tucker Edmonds asserted that the practice of providing patients access to same-day LARC also could help improve Hoosier health.

"We know that LARC is highly effective at preventing unintended pregnancy. Unintended pregnancy is associated with poor pregnancy outcomes, such as premature birth, which is a leading cause of infant mortality," said Tucker Edmonds. "Seeing as unintended pregnancy, premature birth, and infant mortality disproportionately impact women and infants of color and low income populations, it stands to reason that by improving access to same-day LARC, Medicaid could not only cut costs, but could potentially also improve health disparities related to prematurity and infant mortality."

In the paper, the researchers came up with four recommendations for state Medicaid officials from the data compiled through their study:
  • Provide bonus payments for clinicians to incentivize same-day contraceptive access. Doing so would overcome the reimbursement-to-cost differential that leads to the two-visit strategy and mitigate carrying-cost concerns.

  • Create a single, uniform reimbursement structure, preferably as a medical benefit, to mitigate some of the procedural delays that occur when a device has to be ordered for an individual patient as opposed to being used for any presenting patient.

  • Pursue a strategy to purchase LARC devices in bulk and distribute devices up front to clinics desiring to provide same-day LARC access.

  • Develop a policy whereby LARC devices that were ordered for a specific patient but ultimately unused after a certain time could be used for another patient.
Moving forward from the study, Wilkinson said she hopes the findings will help push the needle forward in helping provide access to same-day contraceptives of all kinds to women when and if they need it.

"Access matters, and any barrier to access means that fewer people will actually get to that finish line," Wilkinson said. "When you have people who desire contraception not being able to access it, the outcomes of all our communities are less than ideal. Planned pregnancies are healthier pregnancies, so having same-day access to all forms of contraception is vital."
-end-
Tracey A. Wilkinson, MD, MPH, is an assistant professor of pediatrics with the Department of Pediatrics. Stephen M. Downs, MD, MS, is the Jean and Jerry Bepko Professor of Pediatrics with the Department of Pediatrics, and directs Children's Health Services Research and General Pediatrics at IU School of Medicine. Brownsyne Tucker Edmonds, MD, MPH, MS, is an Assistant Dean for Diversity Affairs and an Associate Professor of Obstetrics and Gynecology with the Department of Obstetrics and Gynecology.

Indiana University School of Medicine

Related Science Articles:

PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.
AAAS and March for Science partner to uphold science
AAAS, the world's largest general scientific organization, announced Thursday that it will partner with the March for Science, a nonpartisan set of activities that aim to promote science education and the use of scientific evidence to inform policy.
Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.
Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.
Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.
More Science News and Science Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...