title: Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of immediate compared with delayed (6 weeks) postpartum etonogestrel implant insertion in preventing future unintended pregnancy.
  
  
  METHODS
  We constructed a decision-analytic model to examine a hypothetical population of women who request a contraceptive implant after giving birth. The timeframe for analysis was from the time of childbirth to 1 year postpartum. Model inputs were derived from a comprehensive literature review. We compared immediate (before discharge from the childbirth hospital stay) compared with delayed (at first postpartum office visit) postpartum placement of the contraceptive implant from a health care system's perspective. Implant insertion and removal, loss to follow-up at the postpartum visit, use of alternative contraceptive methods, and contraceptive failure were incorporated into the model. We calculated the incremental cost of immediate insertion for each pregnancy prevented during the first postpartum year and cost savings associated with pregnancies prevented. One-way sensitivity analyses were also performed. Cost estimates are reported in 2014 U.S. dollars.
  
  
  RESULTS
  Immediate postpartum implant insertion is associated with higher expected cost than delayed insertion ($1,091/patient compared with $650/patient) but is more effective in preventing pregnancies (expected pregnancy rate: 2.4% and 21.6%, respectively). This results in an incremental cost-effectiveness ratio of $2,304 per pregnancy prevented. When taking into consideration medical costs of the resulting unintended pregnancies that could be avoided, immediate implant insertion is expected to save $1,263 per patient.
  
  
  CONCLUSIONS
  Immediate postpartum provision of the contraceptive implant is cost-effective in preventing unintended pregnancies and should be provided to women requesting this form of contraception.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Gariepy
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Duffy
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017135:Desogestrel / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics; D018803:Models, Economic; D049590:Postpartum Period; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel