Cost-benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States.
OBJECTIVE
To examine the hospital and state costs of offering the option of a postpartum intrauterine device (IUD) to an underinsured population of recent immigrants to the United States with Emergency Medicaid (EM) insurance coverage only.


METHODS
This study is a retrospective cohort study comparing the costs of offering a reversible long-acting method of contraception (IUD) postpartum to women with EM and the current policy of covering the obstetrical delivery only. A cost-benefit analysis from the perspective of both the hospital and the state was conducted. A database of EM obstetrical patients from 2002 to 2006 was created from hospital billing records to calculate mean pregnancy costs and revenue, as well as the probability of repeat pregnancy and pregnancy outcome. Probability of IUD uptake and continuation was obtained from hospital records and the literature.


RESULTS
A postpartum IUD program is not cost beneficial from the hospital's perspective, losing 70 cents per dollar spent on the program. However, the state government would save $2.94 for every dollar spent on a state-financed IUD program.


CONCLUSIONS
Considering only the direct costs associated with a repeat pregnancy, a program offering the option of postpartum IUD placement to underinsured women would significantly reduce state expenditures on subsequent pregnancies.
Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA. rodriguezmi@obgyn.ucsf.edu
Maria Isabel
MI
Rodriguez
Aaron B
AB
Caughey
Alison
A
Edelman
Philip D
PD
Darney
Diana Greene
DG
Foster
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics; D054242:Emigrants and Immigrants; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007434:Intrauterine Devices / Q000191:economics* / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000191:economics*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D014481:United States