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Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database.

Abstract

OBJECTIVE

The aim of this study was to evaluate the continuation rates of reimbursed contraceptive methods in French real-world conditions.

METHODS

A retrospective cohort study using a representative sample of the national health insurance database, the General Sample of Beneficiaries (Echantillon Généralistes des Bénéficiaires [EGB]), was performed between 2006 and 2012. Selected women were ≥15 years of age and had started a reimbursed contraceptive method between 2009 and 2012 without prior reimbursement for an implant or an intrauterine contraceptive method between 2006 and 2008. The outcome of interest was the continuation rates, defined as the probability of women initiating a contraceptive method and continuing to use the same method over time. Continuation rates were assessed for up to 2 years. Only the first contraceptive method used during the study period was considered in the analysis. Non-parametric Kaplan-Meier survival analysis was used to assess continuation rates.

RESULTS

A population of 42,365 women representative of the 4,109,405 French women initiating any reimbursed method between 2009 and 2012 was identified in the EGB: 74.5% of women used oral contraceptives, 12.8% the levonorgestrel-releasing intrauterine system (LNG-IUS), 9.2% the copper intrauterine device (Cu-IUD) and 3.5% the subdermal etonogestrel (ENG) implant. The 2 year continuation rates varied from 9.1% for progestin-only oral contraceptives, 27.6% for first to second generation combined oral contraceptives (COCs) and 33.4% for third generation COCs to 83.6% for the ENG implant, 88.1% for the Cu-IUD and 91.1% for the LNG-IUS.

CONCLUSION

This study conducted in real-world conditions showed that long-acting reversible contraceptive (LARC) methods remain rarely used in France despite high continuation rates over 2 years. Increasing the use of LARC methods is therefore a public health priority.

Authors+Show Affiliations

a Gynecology-Obstetric Department , La Conception Hospital , Marseille , France.b MSD France , Courbevoie , France.c Cemka , Bourg-la-Reine , France.b MSD France , Courbevoie , France.c Cemka , Bourg-la-Reine , France.b MSD France , Courbevoie , France.d Epidemiological Cohorts in population Unit, UMS 011, INSERM-UVSQ , Villejuif , France.e Gynecology-Obstetric Department , Hospital Loire Vendée Ocean , Challans , France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30499732

Citation

Agostini, A, et al. "Two Year Continuation Rates of Contraceptive Methods in France: a Cohort Study From the French National Health Insurance Database." The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception, vol. 23, no. 6, 2018, pp. 421-426.
Agostini A, Godard C, Laurendeau C, et al. Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database. Eur J Contracept Reprod Health Care. 2018;23(6):421-426.
Agostini, A., Godard, C., Laurendeau, C., Benmahmoud Zoubir, A., Lafuma, A., Lévy-Bachelot, L., ... Linet, T. (2018). Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database. The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception, 23(6), pp. 421-426. doi:10.1080/13625187.2018.1535653.
Agostini A, et al. Two Year Continuation Rates of Contraceptive Methods in France: a Cohort Study From the French National Health Insurance Database. Eur J Contracept Reprod Health Care. 2018;23(6):421-426. PubMed PMID: 30499732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database. AU - Agostini,A, AU - Godard,C, AU - Laurendeau,C, AU - Benmahmoud Zoubir,A, AU - Lafuma,A, AU - Lévy-Bachelot,L, AU - Gourmelen,J, AU - Linet,T, Y1 - 2018/11/30/ PY - 2018/12/1/pubmed PY - 2019/5/9/medline PY - 2018/12/1/entrez KW - Abortion KW - ENG implant KW - continuation KW - contraceptive methods KW - long-acting reversible contraception (LARC) KW - unintended pregnancy SP - 421 EP - 426 JF - The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception JO - Eur J Contracept Reprod Health Care VL - 23 IS - 6 N2 - OBJECTIVE: The aim of this study was to evaluate the continuation rates of reimbursed contraceptive methods in French real-world conditions. METHODS: A retrospective cohort study using a representative sample of the national health insurance database, the General Sample of Beneficiaries (Echantillon Généralistes des Bénéficiaires [EGB]), was performed between 2006 and 2012. Selected women were ≥15 years of age and had started a reimbursed contraceptive method between 2009 and 2012 without prior reimbursement for an implant or an intrauterine contraceptive method between 2006 and 2008. The outcome of interest was the continuation rates, defined as the probability of women initiating a contraceptive method and continuing to use the same method over time. Continuation rates were assessed for up to 2 years. Only the first contraceptive method used during the study period was considered in the analysis. Non-parametric Kaplan-Meier survival analysis was used to assess continuation rates. RESULTS: A population of 42,365 women representative of the 4,109,405 French women initiating any reimbursed method between 2009 and 2012 was identified in the EGB: 74.5% of women used oral contraceptives, 12.8% the levonorgestrel-releasing intrauterine system (LNG-IUS), 9.2% the copper intrauterine device (Cu-IUD) and 3.5% the subdermal etonogestrel (ENG) implant. The 2 year continuation rates varied from 9.1% for progestin-only oral contraceptives, 27.6% for first to second generation combined oral contraceptives (COCs) and 33.4% for third generation COCs to 83.6% for the ENG implant, 88.1% for the Cu-IUD and 91.1% for the LNG-IUS. CONCLUSION: This study conducted in real-world conditions showed that long-acting reversible contraceptive (LARC) methods remain rarely used in France despite high continuation rates over 2 years. Increasing the use of LARC methods is therefore a public health priority. SN - 1473-0782 UR - https://www.unboundmedicine.com/medline/citation/30499732/Two_year_continuation_rates_of_contraceptive_methods_in_France:_a_cohort_study_from_the_French_national_health_insurance_database_ L2 - http://www.tandfonline.com/doi/full/10.1080/13625187.2018.1535653 DB - PRIME DP - Unbound Medicine ER -