Abstract：
OBJECTIVE: To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth.
METHODS: We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI , defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities.
RESULTS: Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796.
CONCLUSIONS: Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.
METHODS: We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI , defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities.
RESULTS: Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796.
CONCLUSIONS: Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.
摘要：
目的：评估Medicaid的成本效益，包括立即产后长效可逆性避孕（LARC）作为减少未来妊娠间期短（IPI）的策略，严重孕产妇发病率（SMM），和早产。
方法：我们使用TreeAge软件建立了一个决策分析模型，以比较两种情况下的孕产妇健康和成本结果。一个是产后立即LARC是一个覆盖选项，另一个不是，在100,000名接受医疗补助保险的人的理论队列中，他们立即产后并且没有永久避孕。主要结果是增量成本效益比(ICER)，它表示与另一种健康干预相比，从一种健康干预中获得的每增量质量调整生命年（QALY）的增量成本增加。次要结果包括随后的短IPI，定义为从最后一次交付到概念不到18个月的时间，以及SMM，早产,总成本，和QALYs。我们对所有成本进行了敏感性分析，概率，和公用事业。
结果：立即使用产后LARC是具有成本效益的策略，ICER为-11,880,220,102。产后立即使用LARC导致总共减少299次重复分娩，IPI短的新生儿减少178人，少了两例SMM,早产减少34例。产后立即覆盖LARC，增加了25个QALY，节省了2,968,796美元。
结论：在指数化分娩时立即覆盖产后LARC可以改善生活质量并降低医疗补助计划的医疗保健费用。扩大覆盖范围以包括产后立即LARC可以帮助实现最佳IPI并减少SMM和早产。
方法：我们使用TreeAge软件建立了一个决策分析模型，以比较两种情况下的孕产妇健康和成本结果。一个是产后立即LARC是一个覆盖选项，另一个不是，在100,000名接受医疗补助保险的人的理论队列中，他们立即产后并且没有永久避孕。主要结果是增量成本效益比(ICER)，它表示与另一种健康干预相比，从一种健康干预中获得的每增量质量调整生命年（QALY）的增量成本增加。次要结果包括随后的短IPI，定义为从最后一次交付到概念不到18个月的时间，以及SMM，早产,总成本，和QALYs。我们对所有成本进行了敏感性分析，概率，和公用事业。
结果：立即使用产后LARC是具有成本效益的策略，ICER为-11,880,220,102。产后立即使用LARC导致总共减少299次重复分娩，IPI短的新生儿减少178人，少了两例SMM,早产减少34例。产后立即覆盖LARC，增加了25个QALY，节省了2,968,796美元。
结论：在指数化分娩时立即覆盖产后LARC可以改善生活质量并降低医疗补助计划的医疗保健费用。扩大覆盖范围以包括产后立即LARC可以帮助实现最佳IPI并减少SMM和早产。
