title: Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 13.5 mg in contraception.
abstract: BACKGROUND
  Levonorgestrel-releasing intrauterine system (LNG-IUS) 13.5 mg (total content) is a low-dose levonorgestrel intrauterine system for up to 3 years of use. This analysis evaluated the cost-effectiveness of LNG-IUS 13.5 mg in comparison with short-acting reversible contraceptive (SARC) methods in a cohort of young women in the United States from a third-party payer's perspective.
  
  
  METHODS
  A state transition model consisting of three mutually exclusive health states -- initial method, unintended pregnancy (UP) and subsequent method -- was developed. Cost-effectiveness of LNG-IUS 13.5 mg was assessed vs. SARC methods in a cohort of 1000 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 13.5 mg and the existing IUS, LNG-IUS 20 mcg/24 h. The key model output was cost per UP avoided.
  
  
  RESULTS
  Compared to SARC methods, initiating contraception with LNG-IUS 13.5 mg 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 3-year time horizon. Results were most sensitive to the probability of failure on OC, the probability of LNG-IUS 13.5 mg discontinuation and the cost of live births. Scenario analysis suggests that further cost savings may be generated with the initiation of LNG-IUS 20 mcg/24 h in place of SARC methods.
  
  
  CONCLUSIONS
  From a third-party payer perspective, LNG-IUS 13.5 mg is a more cost-effective contraceptive option than SARC. Therefore, women switching from current SARC use to LNG-IUS 13.5 mg are likely to generate cost savings to third-party health care payers, driven principally by decreased UP-related expenditures and long-term savings in contraceptive costs.
authors.affiliation: Office of Population Research, Princeton University, Princeton, NJ 08540, USA; The Hull York Medical School, University of Hull, Hull HU6 7RX, UK.
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.affiliation: IMS Health, London N1 9JY, UK.
authors.forename: Fareen
authors.initials: F
authors.lastname: Hassan
authors.affiliation: IMS Health, London N1 9JY, UK.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Henry
authors.affiliation: Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ 07470, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pocoski
authors.affiliation: Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ 07470, USA. Electronic address: amy.law@bayer.com.
authors.forename: Amy
authors.initials: A
authors.lastname: Law
authors.affiliation: Bayer Pharma AG, Berlin 13553, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Filonenko
mesh_terms: D003267:Contraception / Q000191:economics*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000191:economics*; D016912:Levonorgestrel / Q000008:administration & dosage; D018803:Models, Economic
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Contraception; Cost-effectiveness; Economic evaluation; Levonorgestrel-releasing intrauterine system; Long-acting reversible contraception; Unintended pregnancy