Immediate Postabortal IUD Placement Reduces Costs for Public Payers, Study Finds

February 28, 2013 — "Cost Analysis of Immediate Postabortal IUD Insertion Compared to Planned IUD Insertion at the Time of Abortion Follow Up," Salcedo et al., Contraception, January 2013.

The "untapped potential for both reduction of unintended pregnancies and public savings with postabortal [intrauterine device] insertion is substantial," according to a research team led by Jennifer Salcedo at the University of California-Los Angeles.

The researchers developed a study to evaluate the potential public sector savings of "immediate postabortal IUD" placement for women in California, one of the "few states to fund both abortion and contraception for low-income women." They noted that for many clinics throughout the U.S., "[a] key barrier to immediate IUD insertion is the complexity of the reimbursement process, including separate funding sources for abortion and contraception care."

The researchers also noted that the "cost efficacy of contraception is well established" and that IUDs "provide the greatest cost savings among reversible methods, saving more than US$7 for every dollar spent." Moreover, postabortal IUD placement has been shown to be safe and effective and to decrease repeat abortions, even among patients "with optimal access to contraception," they wrote.

Methods

The researchers developed a decision-analytic model to compare two strategies for IUD provision: immediate postabortal insertion and planned insertion at follow up. The model took into account variables that could affect cost savings related to IUD use, including typical failure rates of contraceptive methods, pregnancy rates, possible pregnancy outcomes and the cost of public insurance programs for women and children in California.

The researchers used the model to determine public program costs and unintended pregnancy rates for the two strategies. They modeled three sets of costs at one- and five-year horizons: the medical costs of contraception and pregnancy-related care, the costs of public health insurance for which a woman and her children were expected to be eligible, and the costs of social programs in which they were expected to participate.

Results

"Immediate postabortal IUD placement decreases public program expenditures for all considered costs," the researchers found. Specifically, for each California woman who receives a publicly funded abortion with immediate IUD placement, public programs can expect to save $111 over one year and $810 over five years in direct medical costs. The savings would increase to $1,956 over one year and $4,296 over five years if public health insurance costs and social program costs are included.

The study also found that for every 1,000 low-income women who receive immediate postabortal IUD placement, "more than 400 pregnancies, 180 deliveries and 160 abortions will be averted" over five years.

Additional analyses showed that the findings were robust, according to the researchers. For instance, their models determined that immediate postabortal IUD placement saved money on direct medical costs in 61% of scenarios after one year and in 84% of scenarios after five years. When public health insurance costs and social program costs over five years were included, immediate IUD placement saved money in 89% and 90% of scenarios, respectively.

Discussion

"Immediate insertion of postabortal IUDs reduces unintended pregnancy and saves public funds," the researchers wrote. They noted that their findings held even when "IUD device [costs], IUD expulsion rates and rates of IUD placement at abortion follow up considerably exceed those reported in medical literature."

The researchers added that their projections likely underestimated the cost savings of immediate postabortal IUD placement for multiple reasons, including their assumption that women can only "experience pregnancy once per year-long model cycle" and the fact that the "model looks only at public program costs and does not account for the private costs of unintended pregnancy and its effects on a woman's quality of life."

They wrote, "The findings of our analysis highlight the economic inefficiency of programs that separate abortion and contraception." They concluded that "decreasing barriers to immediate postabortal IUD insertion is an opportunity to increase the quality of reproductive health care while decreasing unintended pregnancies and lowering public costs."