• Daniela Farah, Teresa Raquel de Moraes Andrade, Dayan Sansone, Batista Castello GirãoManoel JoãoMJDepartment of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil., and FonsecaMarcelo Cunio MachadoMCMDepartment of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: mcmf.
• Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
• Am J Prev Med. 2022 Jan 1; 62 (1): 114-121.

IntroductionThe 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.MethodsA 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.ResultsCopper 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.ConclusionsAccording 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.Copyright © 2021. Published by Elsevier Inc.

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