Presentation (CTI)

OBJECTIVES: To quantify trends in the utilization of levonorgestrel-releasing intrauterine devices (L-IUD) and estimate the costs potentially avoided through the reduction of unplanned pregnancies (UP) in an insured population.
METHODS: Retrospective cohort study including beneficiaries aged 18-34 years, followed between 2020 and October 2025. The cohort included prior users and new insertions of 52 mg and 19.5 mg L-IUDs. Low-risk pregnancies composed the second cohort for cost analysis. All data were obtained from administrative records of a large Brazilian Health Insurance Company (Unimed Campinas). Prenatal and delivery costs were calculated using reimbursed amounts, and savings scenarios were modeled based on UP rates reported in the literature (32.8%-65.7%).
RESULTS: Among 251,419 beneficiaries, 20,377 pregnancies occurred (8.1%). A total of 52,376 L-IUD users were identified, including 16,398 new insertions (50.5% L-IUD 52 mg; 49.5% L-IUD 19.5 mg). Insertions increased by 80% through 2023, followed by a decline in 2024-2025. The annual pregnancy incidence showed a progressive decrease (3.5%-22%), amounting to a cumulative reduction of 41.8%. The mean cost of prenatal care and delivery was US$ 1.961,34, resulting in total spending of US$ 39.9 million during the period. Considering a UP rate of 65.7%, the associated financial impact was US$ 26.2 million. In prevention scenarios attributing 32.8% or 65.7% reduction in UP to L-IUD use, estimated savings were US$ 7.4 million and US$ 14.8 million, respectively.
CONCLUSIONS: Hormonal IUD use demonstrated a strong association with reduced pregnancy rates and substantial potential for cost savings for the Brazilian Health Insurance Company. Wider adoption of long-acting contraceptive methods represents a cost-effective, high-impact strategy to mitigate UP and their associated financial consequences.