Introduction
The use of long-acting reversible contraceptives is low among adolescents owing to
the high up-front cost. In this study, a 5-year cost-effectiveness model and budget
impact analysis were used to compare the use of long-acting reversible contraceptives
with the use of combined oral contraceptives among Brazilian adolescents.
Methods
A Markov model was developed to mirror the clinical and economic effects of long-acting
reversible contraceptives among sexually active Brazilian adolescents in the public
health system for a 5-year duration, starting from 2018. The costs were expressed
in U.S.$, and a 5% discount rate was applied for both costs and benefits. Model inputs
included costs of the contraceptive methods, contraceptive discontinuation and adherence
rates, abortion, and birth costs associated with unintended pregnancies. The model
outcomes were avoided pregnancies, abortions, and births. Univariate and probabilistic
sensitivity analyses were conducted.
Results
Copper intrauterine device use was dominant 100% of the time for all outcomes, and
a budget impact analysis revealed a cost savings of $422,431,269.10 in the 5-year
period. Levonorgestrel intrauterine system and subdermal implant use were cost effective
for all outcomes. The budget impact analyses revealed costs of $65,645,417.54 for
levonorgestrel intrauterine system and $302,852,972.12 for subdermal implant use during
the 5-year study period.
Conclusions
According to this Brazilian model, copper intrauterine device use is dominant, and
levonorgestrel intrauterine systems and subdermal implants are more cost effective
than combined oral contraceptives.
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