Background: Long-acting reversible contraceptives (LARCs), comprised of hormonal intrauterine devices (HIUDs), non-hormonal IUDs (NHIUDs) and implants, are contraceptives that, once inserted, are highly effective and require minimal continued effort for a patient. However, trends in new use in outpatient settings are not well characterized at the national level.
Objectives: To estimate outpatient LARC insertion incidence in a patient population with employer-sponsored private insurance from 2010 through 2020.
Methods: We conducted a retrospective cohort study using the Merative MarketScan Commercial Claims and Encounters Database. We constructed a cohort of women aged 15-54 who had continuous enrollment in MarketScan for ≥180 days between January 1, 2010 and December 31, 2020. LARC insertions were required to have a Current Procedural Terminology code (indicating the insertion) and a Healthcare Common Procedure Coding System code (classifying the type of LARC) within 180 days. We defined a new LARC insertion by an insertion code without a removal code recorded ≤180 days preceding the insertion. We calculated the monthly incidence of new LARC insertions. To account for fluctuations in MarketScan coverage, monthly estimates were standardized to the age and state/territory distribution of January 2010. For each year, we calculated the proportion of insertions attributed to implants, HIUDs, and NHIUDs.
Results: We identified 1,372,594 new LARC insertions from 2010-2020. The monthly standardized incidence increased from 6.0 insertions per 10,000 people in January 2010 to 14.1 in December 2020. Incidence from March through May 2020 (range: 11.4 to 6.2/10,000) was lower than other months’ incidence in 2020. Insertion incidence recovered by July 2020 (14.2/10,000), compared to January (15.2/10,000) and February (13.8/10,000) 2022. The average monthly incidence was lower in 2020 (12.7/10,000) compared to 2016-2019 (13.0/10,000-14.5/10,000). The share of LARCS that were HIUDs was stable across the study period (~68% of new insertions). By contrast, implant use increased from 8.5% in 2010 to 21.0% in 2020, offset by decreases in NHIUD use from 19.9% in 2010 to 10.9% in 2020. Our results were robust against changes to our inclusion criteria and alternate definitions of LARC insertions.
Conclusions: LARC insertion incidence more than doubled from January 2010 to December 2020. There was a substantial decrease in insertion incidence during the early months of the COVID-19 pandemic, after which incidence recovered. However, despite this recovery, the monthly average incidence in 2020 was low relative to prior years. These results can facilitate allocation of resources, evaluation of counseling practices, and formulation of policy that reflects patient desires and needs.
