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• W809478238 abstract "Introduction Long acting reversible contraception (LARC) methods consist of the intrauterine device (IUD) and subdermal implant. These birth control methods provide highly effective contraception that last from 3-10 years. The IUD comes in both medicated (levonorgestrel-containing) and copper-containing form while the implant is inserted sub-dermally in the upper arm under local anesthesia and releases a small continuous amount of the etonogestrel. Despite high efficacy, LARC remains underutilized, with only 8.5% of contraceptive-using American women reporting its use (Finer 2012) . The relationship between low LARC use and unintended pregnancy is documented (Secura 2013, Blumenthal 2013, Blumenthal 2011). In the United States, more than half of all pregnancies are unintended, with an estimated annual direct cost of $4.6 billion (Trussell 2013). There are two well-accepted methods of LARC initiation – immediate postpartum and interval insertion. In “immediate insertion,” LARC are placed within 72 hours of delivery, prior to hospital discharge. In contrast, “interval insertion” encompasses delayed insertion at 4-8 weeks postpartum as well as LARC initiation that is not related to pregnancy. Although immediate postpartum LARC initiation has been commonly practiced in other parts of the world for the last three decades (Grimes 2010), only a few centers in the US offer this service. The American College of Obstetricians and Gynecologists (ACOG) recommends the use of LARC in the immediate postpartum period to aid in reducing unintended pregnancy rates and rapid repeat pregnancies (ACOG 2009, 2011). In the state of New Mexico, about 56% of pregnancies were unintended, with 58% ending in live births (NM PRAMS 2008). Data from the University of New Mexico Hospital (UNMH) in 2002 show that about 12% of postpartum women chose delayed LARC as their method of birth control. At best, only 60% of these women actually had a LARC placed (Ogburn 2005). More recent data from 2006-2011 indicate an increasing number of women who plan to use birth control after delivery, with preference for the implant and the IUD (Singh 2014). Previous economic analysis of contraceptive methods show that, overall, LARC use leads to cost savings and quality adjusted life years compared to methods which require patient adherence such as oral contraceptive pills (Sonnenberg 2004, Secura 2013). Although previous research studies have been published regarding the cost effectiveness of LARC use in general, no cost-effective or cost utility study have directly analyzed immediate postpartum versus interval LARC use in the US." @default.
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• W809478238 date "2014-01-01" @default.
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• W809478238 title "Literature search strategy for economic evaluations of long acting reversible contraception (LARC)" @default.
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