title: Retrospective analysis of the impact of increasing access to long acting reversible contraceptives in a commercially insured population.
abstract: BACKGROUND
  Unintended pregnancies have been shown to be associated with high costs for the healthcare system, among other adverse impacts, but could still account for up to 51 % of pregnancies in the US. Improvements in contraception among women are needed. Long acting reversible contraceptives (LARCs), which have proved their safety and efficacy, have been found to significantly decrease the risk of unintended pregnancy. Yet they are still marginally employed. This study aims at investigating the evolution of LARC use over 15 years and at assessing the impact of the introduction of newer LARCs on LARC use relative to all contraceptive use.
  
  
  METHODS
  This retrospective study identified women with LARC or short acting reversible contraceptive (SARC) claims from a US insurance claims database (01/1999-03/2014). Yearly proportions of LARC users relative to all contraceptive users were reported. Generalized estimating equation models were used to assess the impact of user characteristics, such as age group (15-17, 18-24, 25-34, and 35-44), and of time periods related to the introduction of new LARCs (01/2001: Mirena, 07/2006: Implanon, 01/2013: Skyla) on LARC use.
  
  
  RESULTS
  A total of 1,040,978 women were selected. LARC use increased yearly from 0.6 % (1999) to 16.6 % (2013) among contraceptive users. Time periods associated with the introduction of a newer LARC were significant predictors of LARC use; women in 2006-2012 and 2013-2014 were respectively 3.7-fold (95 % CI:3.57-3.74) and 6.6-fold (95 % CI:6.43-6.80) more likely to use LARCs over SARCs relative to women in 2001-2006. The increase in LARC use was especially pronounced in young women. Compared to women aged 18-24 in 2001-2006, women aged 18-24 in 2006-2012 and 2013-2014 were respectively 6.4-fold (95 % CI:5.91-6.86) and 14.7-fold (95 % CI:13.59-15.89) more likely to use LARCs over SARCs.
  
  
  CONCLUSIONS
  This broadly representative commercial claim-based study showed that the proportion of privately insured women of childbearing age using LARCs increased over time and that the introduction of newer LARCs corresponded with significant increases in overall LARC use. Future research is needed to assess LARC use in uninsured or publicly-insured populations.
authors.affiliation: Bayer HealthCare Pharmaceuticals Inc, 100 Bayer Blvd, Whippany, NJ, 07981, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Law
authors.affiliation: Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada. dominic.pilon@analysisgroup.com.
authors.forename: Dominic
authors.initials: D
authors.lastname: Pilon
authors.affiliation: Bayer HealthCare Pharmaceuticals Inc, 100 Bayer Blvd, Whippany, NJ, 07981, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lynen
authors.affiliation: Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Laliberté
authors.affiliation: Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gozalo
authors.affiliation: Groupe d'analyse, Ltée, 1000 De La Gauchetière West, Bureau 1200, Montreal, QC, H3B 4W5, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: Analysis Group, Inc., 10th Floor, 111 Huntington Ave, Boston, MA, 02199, USA.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003267:Contraception / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D003268:Contraception Behavior / Q000639:trends; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007434:Intrauterine Devices / Q000706:statistics & numerical data / Q000639:trends; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: Contraception; LARC; SARC