Objective: To conduct a cost-effectiveness analysis of contraceptives available in the United States from a payer's perspective. Methods: A Markov model was constructed to simulate method failure (defined as ectopic pregnancy, abortion, or full-term birth) and costs among 17 contraceptive methods over a 5-year period: vasectomy, tubal ligation, injectable, implant, copper-T IUD, LNG-20 IUS, oral contraceptives, diaphragm, male condom, female condom, spermicides, sponge, patch, NuvaRing, withdrawal, periodic abstinence and no method. In each yearly cycle, subjects transition to “continue contraception”, “method failure” or “plan disenrollment”. Subjects remain on the method for the model duration after method failure or adverse effect. We assumed that 60% of unintended births are mistimed and would occur two years later. Failure rate, adverse event rates, and resource utilization were derived from comprehensive literature review and supplemented with expert opinion. Unit costs were obtained from published fee schedules and drug prices. Future costs and effectiveness were discounted at 3%/year. Sensitivity analyses were performed on cost and failure rates. Results: Any contraceptive method is superior to “no method” in terms of costs and success rate. The three least expensive methods were copper-T IUD ($645), vasectomy ($713) and LNG-20 IUS ($930). The most effective methods (=99.6% success rate) were vasectomy, implant, tubal ligation, LNG-20 IUS and copper-T IUD. Results were sensitive to variations in cost of contraception method, cost of unintended pregnancy and plan disenrollment rates. Moreover, with a longer time horizon, methods with high initial costs (ie, copper-T IUD, vasectomy and LNG-20 IUS) and high effectiveness rates become more cost-effective. Conclusion: Copper-T IUD, vasectomy and LNG-20 IUS are among the most effective methods currently available in the US market. This analysis demonstrates that differences in efficacy, method costs, cost of unintended pregnancies and time horizon are influential factors that determine the overall value of a contraception method.