Background

Clinical guidelines support inpatient postpartum intrauterine device insertion. However, inpatient placement remains infrequent, in part because of inconsistent private insurance reimbursement.

Objective

The purpose of this study was to explore how the payer’s costs and number of unintended pregnancies associated with a postpartum intrauterine device differed on the basis of placement timing.

Study Design

Using a decision tree model and following a hypothetical cohort of people who intend to use an intrauterine device after their delivery, we conducted a cost analysis comparing the planned approach of inpatient vs outpatient postpartum insertion. Using a 2-year time horizon, the probability and cost estimates were derived from literature review. Our primary outcome was the total accrued costs to the payer. Secondarily, we examined the rates of early repeat pregnancy and sensitivity to estimates of key inputs, including the expulsion rates and the intrauterine device cost.

Results

Although an inpatient intrauterine device placement’s upfront costs were higher, the total cost of this approach was lower. Including the costs of managing expulsions and complications, our model suggests that for every 1000 people desiring a postpartum intrauterine device, the intended inpatient intrauterine device placement resulted in total cost savings of $211,100 and the prevention of 37 additional pregnancies compared with outpatient placement. The inpatient cost savings were superior to the outpatient savings, largely because of a known high proportion not returning for outpatient placement and the resulting higher number of unintended pregnancies among the patients desiring outpatient placement. In sensitivity analyses, we found that the total cost to the payer was sensitive to the probability of expulsion after immediate postpartum intrauterine device placement.

Conclusion

For beneficiaries desiring postpartum intrauterine device, payers are likely to save money by fully reimbursing inpatient intrauterine device placement rather than incentivizing placement at the frequently missed postpartum visit. These results support the financial case for private insurers to fully and separately reimburse (ie, “unbundle” from the single payment for delivery) inpatient postpartum intrauterine device placement.

中文翻译：

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制定立即产后宫内节育器的财务案例：预算影响分析

背景

临床指南支持住院患者产后宫内节育器置入。然而，住院安置仍然很少，部分原因是私人保险报销不一致。

客观的

本研究的目的是探讨支付者的费用和与产后宫内节育器相关的意外怀孕数量如何因放置时间而不同。

学习规划

使用决策树模型并跟踪一组在分娩后打算使用宫内节育器的假设人群，我们进行了成本分析，比较了住院患者与门诊患者产后置入的计划方法。使用 2 年的时间范围，概率和成本估计来自文献回顾。我们的主要结果是付款人的总应计成本。其次，我们检查了早期重复妊娠率和对关键输入估计的敏感性，包括排出率和宫内节育器成本。

结果

尽管住院宫内节育器放置的前期成本较高，但这种方法的总成本较低。包括管理驱逐和并发症的成本，我们的模型表明，对于每 1000 名需要产后宫内节育器的人，与门诊放置相比，预期的住院宫内节育器放置可节省 211,100 美元的总成本并预防 37 次额外怀孕。住院费用节省优于门诊费用，这主要是因为已知的高比例不返回门诊就诊以及由此导致希望门诊就诊的患者中有更多的意外怀孕。在敏感性分析中，

结论

对于希望产后宫内节育器的受益人，付款人可能会通过全额报销住院宫内节育器放置而不是在经常错过的产后就诊时鼓励放置来节省资金。这些结果支持私人保险公司完全和单独报销（即，从单一的分娩付款中“解绑”）住院产后宫内节育器放置的财务案例。