Immediate postpartum long-acting reversible contraception can improve QoL and reduce Severe Maternal Morbidity: Study

A recent study revealed that quality of life can be improved, and health care costs can be reduced at the time of index delivery by immediate postpartum long-acting reversible contraception (LARC). The study results were published in the journal Obstetrics & Gynecology.

Postpartum contraception is a safe and effective method to reduce severe maternal morbidity (SMM) by preventing unintended pregnancy and reducing short-interval pregnancy births. Short-interval pregnancy births are those that are less than 18 months from prior birth to subsequent conception. Hence, researchers conducted a study to assess the cost-effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce short interpregnancy intervals (IPI), severe maternal morbidity (SMM), and preterm birth rates by developing a decision analytic model.

By employing the TreeAge software, a decision-analytic model was built to compare maternal health and cost outcomes in two scenarios. One where immediate postpartum LARC was a Medicaid-covered option and the other where it was not. The study focused on a hypothetical cohort of 100,000 postpartum individuals on Medicaid who had not opted for permanent contraception. The primary outcome of measurement was the incremental cost-effectiveness ratio (ICER), which indicates the cost increase required per additional quality-adjusted life year (QALY) gained from one health intervention over another. Secondary outcomes of interest included the rate of short IPI (defined as an interpregnancy interval of less than 18 months), the occurrence of SMM, preterm births, overall costs, and QALYs. Sensitivity analyses were conducted to account for variations in costs, probabilities, and utilities in the model.

Findings:

• The analysis found that providing immediate postpartum LARC was a cost-effective strategy.
• The ICER was calculated at -$11,880,220,102, indicating significant cost savings.
• Immediate postpartum LARC coverage led to 299 fewer repeat births, 178 fewer short IPIs, two fewer cases of SMM, and 34 fewer preterm births.
• The intervention also resulted in 25 additional QALYs and a total cost saving of $2,968,796 for Medicaid.

Thus, the study concluded that providing Medicaid coverage for immediate postpartum LARC at the time of delivery is both a cost-saving and life-quality-enhancing strategy. By reducing short IPIs, SMM, and preterm birth rates, this policy can improve overall maternal and neonatal health outcomes while also reducing healthcare costs for Medicaid. Expanding Medicaid coverage to include immediate postpartum LARC could help achieve optimal interpregnancy intervals and decrease the risks associated with SMM and preterm birth.

TAKE-HOME MESSAGE

• This study evaluated the cost-effectiveness of immediate postpartum long-acting reversible contraception (LARC) coverage by Medicaid to reduce the rates of short interpregnancy intervals, preterm birth, and severe maternal morbidity.
• A model was created comparing maternal health and cost outcomes in a setting where immediate postpartum LARC was covered by Medicaid and one where LARC was not covered.
• Immediate postpartum LARC coverage was more cost-effective and saved approximately 3 million dollars. The use of immediate postpartum LARC led to reductions in the rates of repeat births, short-interval pregnancy births, severe maternal morbidity, and preterm births.
• Clinicians should counsel patients on the option of immediate postpartum LARC and the potential benefits, such as reductions in the rates of short interpregnancy interval births, severe maternal morbidity, and preterm births.

Further reading: Bullard, Kimberley A et al. “Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.” Obstetrics and gynecology vol. 144,3 (2024): 294-303. doi:10.1097/AOG.0000000000005679