Medicaid Savings from the Contraceptive CHOICE Project: a Cost Savings Analysis

Abstract Background Forty-five percent of U.S. births are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods, intrauterine devices and contraceptive implants, have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. Objective To conduct a cost savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost conception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. Study Design The CHOICE Project was a prospective cohort study of 9,256 reproductive-age women, enrolled between 2007 and 2011 and followed until October 2013. This analysis includes 5,061 CHOICE Project participants who were current Missouri Medicaid beneficiaries or uninsured and reported household incomes less than 201% of the federal poverty line. We created a simulated comparison group of women receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the CHOICE Project. Data about contraceptive use for the comparison group (N=5,061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison accounting for difference in the two populations, we used our simulation model to estimate total CHOICE Project costs and total comparison group costs. We reported all costs in $2013 to account for inflation. Results Among the CHOICE Project participants included, the uptake of intrauterine devices and implants was 76.1% compared to 4.8% among the comparison group. The estimated contraceptive cost for the simulated CHOICE Project group was $4.0 million versus $2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated CHOICE Project group compared to the comparison group were 927 and 483 respectively, representing a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the CHOICE Project was $5.0 million (40.7%) over the project duration. Conclusions A program providing counseling and no-cost contraception yields substantial cost savings due to increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.