title: Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?
abstract: OBJECTIVE
  The objective of the study was to determine the cost-effectiveness of a hypothetical state-funded program offering immediate postpartum implant (IPI) insertion for adolescent mothers.
  
  
  METHODS
  Participants in an adolescent prenatal-postnatal program were enrolled in a prospective observational study of IPI insertion (IPI group, n = 171) vs standard contraceptive initiation (comparison group, n = 225). Implant discontinuation, repeat pregnancies and pregnancy outcomes were determined. We compared the anticipated public expenditures for IPI recipients and comparisons at 6, 12, 24, and 36 months postpartum using the actual outcomes of this cohort and Colorado Medicaid reimbursement estimates. Costs were normalized to 1000 adolescents in each arm and included 1 year of well-baby care for delivered pregnancies.
  
  
  RESULTS
  At 6 months, the expenditures of the IPI group exceed the comparison group by $73,000. However, at 12, 24, and 36 months, publicly funded IPIs would result in a savings of more than $550,000, $2.5 million, and $4.5 million, respectively. For every dollar spent on the IPI program, $0.79, $3.54, and $6.50 would be saved at 12, 24, and 36 months. Expenditures between the IPI and comparison groups would be equal if the comparison group pregnancy rate was 13.8%, 18.6%, and 30.5% at 12, 24, and 36 months. Actual rates were 20.1%, 46.5%, and 83.7%.
  
  
  CONCLUSIONS
  Offering IPIs to adolescent mothers is cost effective. Payors that do not currently cover IPI should integrate these data into policy considerations.
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, Anschutz Medical Campus, University of Colorado, Aurora, CO. Electronic address: leo.han@ucdenver.edu.
authors.forename: Leo
authors.initials: L
authors.lastname: Han
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, Anschutz Medical Campus, University of Colorado, Aurora, CO.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, Anschutz Medical Campus, University of Colorado, Aurora, CO.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, Anschutz Medical Campus, University of Colorado, Aurora, CO.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tocce
mesh_terms: D000293:Adolescent; D003120:Colorado; D003271:Contraceptive Agents, Female / Q000191:economics*; D003362:Cost-Benefit Analysis; D017135:Desogestrel / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000191:economics*; D008484:Medicaid; D010298:Parity; D011181:Postnatal Care / Q000191:economics* / Q000379:methods; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics / Q000379:methods; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel
keywords: Medicaid; adolescent; cost; immediate contraception; implant; long-acting reversible contraception; postpartum