A five-year cost-consequence analysis of extended-use etonogestrel implant versus other contraceptives

While multiple reversible contraceptives are available, long-acting reversible contraception (LARC) offers multi-year protection with minimal user burden. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This analysis evaluated whether the acquisition costs for the etonogestrel implant are offset via pregnancy prevention and pregnancy-related expenditures.

A discrete Markov chain model with 5-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a United States managed care perspective. Sensitivity analyses were also conducted.

The etonogestrel implant followed by IUDs were associated with the fewest pregnancies (60 [etonogestrel implant], 105 [3-year IUD], and 104 [≥5-year IUD], respectively) and the lowest per-woman costs ($3,428 [etonogestrel implant], $5,275 [3-year IUD], and $4,728 [≥5-year IUD], respectively). Cost offsets occurred in Year 1 and increased incrementally through Year 5. In comparison, branded and generic OC resulted in 299 and 323 pregnancies, respectively, and $8,477 and $8,678 per-woman costs; the vaginal ring, injection, and patch resulted in 328, 265, and 327 pregnancies, respectively, with per-woman costs ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs.

The etonogestrel implant was the most cost-effective contraceptive option when modeled over a 5-year period, offering the fewest pregnancies and lowest associated healthcare costs. Policies and practices that support initiation and continuation of the etonogestrel implant can enhance both clinical outcomes and overall cost-effectiveness.