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.

摘要

目的：本研究的目的是评估现实生活中法国群众使用可报销报销避孕方式的持续率。

方法：在2006年至2012年间, 选用国民健康保险数据库的代表性人群, 即受益者的一般样本（官员一样的样本[EGB]）进行了回顾性队列研究。入选的女性年龄为15岁, 在2006年至2012年期间开始使用能够报销避孕的方法, 而在2006年至2008年期间没有使用植入避孕方法或宫内避孕方法进行报销。感兴趣的结果是持续率, 定义为妇女开始使用避孕方法并且在一段时间内持续使用同一方法的可能性。持续率的评估长达2年。分析只考虑研究期间使用的第一种避孕方法。非参数Kaplan–Meier生存分析用于评估持续率。

结果：在4109405的法国女性中有42365名有代表性的妇女在2009年到2012年开始了能够报销的避孕方式且被认定为EGB：74.5%的女性使用口服避孕药, 12.8%的女性使用左炔诺孕酮宫内缓释系统(LNG-IUS), 9.2%的使用铜制宫内节育器(Cu-IUD)及3.5%的使用皮下依托孕烯（ENG）植入。单纯使用孕激素口服避孕药的2年持续率为9.1%, 第一代至第二代复发口服避孕药（COCs）的持续率为27.6%, 第三代COCs的持续率为33.4%, 而ENG植入的持续率为83.6%, Cu-IUD的持续率为88.1%, LNG-IUS的持续率为91.1%。

结论：本研究在现实的生活条件下进行的研究表明：尽管法国长期使用的可逆性避孕（LARC）方法的持续性超过2年, 但仍然很少使用。因此, 增加LARC方法的使用是一项公共卫生有先考虑事项。

Keywords:

• Abortion
• continuation
• contraceptive methods
• ENG implant
• long-acting reversible contraception (LARC)
• unintended pregnancy

Disclosure statement

CG, ABZ and LLB are employed by MSD France. AA and TL have received fees from MSD France as expert advisers. CL and AL are employed by Cemka, which is in receipt of a grant from MSD France. JG is employed by INSERM and has no conflict of interest to declare.

Additional information

Funding

This study was funded by MSD France, a subsidiary of Merck & Co, Inc.