Timing of postpartum intrauterine device placement: a cost-effectiveness analysis  

Oleh:

Washington, Chantel I. ; Jamshidi, Roxanne ; Thung, Stephen F. ; Nayeri, Unzila A.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Fertility and Sterility (keterangan: ada di ClinicalKey) vol. 103 no. 01 (Jan. 2015), page 131-137.
Topik: Contraception; QALY; utility; expulsion; pregnancy
Fulltext: PIIS0015028214022092.pdf (323.0KB)

Ketersediaan

Perpustakaan FK Nomor Panggil: F02.K Non-tandon: tidak ada Tandon: 1

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Isi artikel

Objective To determine if immediate postpartum (PP) intrauterine device (IUD) placement prevents pregnancy and is cost-effective compared with routine placement. Design We developed a decision-analysis model to determine the number of pregnancies prevented and the cost-effectiveness of immediate PP IUD placement defined as within the first 10 minutes of placental expulsion compared with routine placement at the PP visit. Associated costs and probability estimates for adherence to PP follow-up, IUD placement, expulsion, and pregnancy were determined from the literature. Setting Hospital and outpatient facility. Patient(s) Women desiring PP IUDs. Intervention(s) IUD placement. Main Outcome Measure(s) The main outcome measure was the number of pregnancies prevented per 1,000 women. The secondary outcome was an incremental cost-effectiveness ratio (ICER) defined as the marginal cost per quality-adjusted life-year (QALY) gained. An ICER of <$50,000/QALY gained was considered to be cost-effective. Result(s) Immediate PP IUD placement prevented 88 unintended pregnancies per 1,000 women over a 2-year time horizon. Immediate PP IUD placement was the dominant strategy. For every 1,000 women who desired a PP IUD, attempted immediate PP placement resulted in a cost savings of $282,540 and a gain of 10 QALYs. The model is most sensitive to the cost of an undesired pregnancy. When the cost of a live birth is <$6,000, immediate placement is no longer cost-saving but remains cost-effective. Monte Carlo simulation demonstrates that immediate PP IUD placement is cost-effective in 99% of simulations. Conclusion(s) Immediate PP IUD placement is a dominant strategy that prevents unintended pregnancy.

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