University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209.
University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209.
Contraception. 2018 Jul;98(1):63-68. doi: 10.1016/j.contraception.2018.03.029. Epub 2018 Mar 21.
The objective was to assess changes in long-acting reversible contraceptive (LARC) method uptake at Utah's Title X clinics before and after introduction of a new, low-cost levonorgestrel (LNG) 52mg IUD (Liletta®).
We conducted a retrospective medical record review of LARC visits occurring at seven Title-X family planning clinics in Utah before the introduction of the low-cost LNG IUD (preintroduction period: 01/01/2014-04/30/2015) and after (postintroduction period: 05/01/2015-03/31/2016). We ran segmented, interrupted time series ordinary least squares regression models using Newey-West standard errors to assess both the change in numbers of women initiating any LARC method and the average payment amount per LARC method. We evaluated both the low-cost LNG IUD and all LARC methods.
At the outset of preintroduction period, there were 29.2 [95% confidence interval (CI): 20.1-38.4] monthly LNG IUD insertions. Immediately postintroduction, there was a significant level of increase of 14.4 LNG IUD insertions the first month (95% CI: 2.0-26.8) followed by a significant trend increase each month of 2.4 additional LNG IUD insertions (95% CI: 0.32-4.47). Postintroduction, there was a significant level of remitted-payment decrease from all sources of -$240.43 per LNG IUD (95% CI: -311.02 to 168.87) followed by a significant monthly trend decrease of -$23.01 per LNG IUD (95% CI: -32.02 to -13.98). There were minimal changes in uptake and payment of other LARC methods following the introduction of the low-cost LNG IUD.
Following introduction of a low-cost LNG IUD at Title X clinics, LNG IUD initiation increased and average payment for the method decreased.
Reducing the cost of LARC methods, both to clinics and to patients, is essential to expanding access. Additional efforts to develop and provide access to low-cost copper IUDs and subdermal implants as well as novel LARC methods should be continued.
评估在引入新型低成本左炔诺孕酮（LNG）52mg 宫内节育器（Liletta®）之前和之后，犹他州的 Title X 诊所中长效可逆避孕（LARC）方法的采用率变化。
我们对在犹他州的七个 Title X 计划生育诊所进行的 LARC 就诊进行了回顾性病历审查，这些诊所分别在引入低成本 LNG IUD 之前（介绍前时期：2014 年 1 月 1 日至 2015 年 4 月 30 日）和之后（介绍后时期：2015 年 5 月 1 日至 2016 年 3 月 31 日）。我们使用 Newey-West 标准误差运行分段、中断时间序列普通最小二乘回归模型，以评估开始使用任何 LARC 方法的女性数量和每种 LARC 方法的平均支付金额的变化。我们评估了低成本 LNG IUD 和所有 LARC 方法。
在介绍前时期开始时，每月有 29.2 例 LNG IUD 插入（95%置信区间 [CI]：20.1-38.4）。引入后立即，第一个月 LNG IUD 插入量显著增加了 14.4 例（95%CI：2.0-26.8），随后每月 LNG IUD 插入量呈显著趋势增加 2.4 例（95%CI：0.32-4.47）。引入后，LNG IUD 的所有来源的报销金额显著降低了 240.43 美元（95%CI：-311.02 至 168.87），随后每月 LNG IUD 的报销金额呈显著趋势下降了 23.01 美元（95%CI：-32.02 至-13.98）。引入低成本 LNG IUD 后，其他 LARC 方法的采用率和支付额变化不大。
在 Title X 诊所引入低成本 LNG IUD 后，LNG IUD 的起始使用增加，该方法的平均支付金额降低。
降低 LARC 方法的成本，无论是对诊所还是对患者，对于扩大服务范围至关重要。应继续努力开发和提供低成本铜宫内节育器和皮下埋植剂以及新型 LARC 方法。
