What Is the Economic Cost of Unplanned Pregnancy Following Hysteroscopic Sterilization in the US? A New National Estimate Based on Essure® Procedure Prevalence, Failure Rates and Workforce Productivity

Although hysteroscopic sterilization (HS) (Essure ®) has been available in the US since 2002, there is disagreement regarding its efficacy, and there has been no study of the economic impact of HS failure. Our investigation examined the economic consequences of contraceptive failure with Essure in the US. Contraceptive failure rates (CFR) of 5.7%, 7.7% and 9.6% were applied to the US cohort of HS patients (n = 600,000). Direct economic impact of productivity losses resulting from unplanned conceptions after HS was calculated by factoring Essure failure rate, the exposed population, US female labour force participation, unemployment rate, time away from work owing to vaginal delivery or pregnancy termination and weekly wages. For the 9.6% CFR scenario, US workforce productivity loss from unplanned pregnancy and delivery was estimated at 771,065 days (2,112 years). Productivity loss secondary to conception and subsequent termination of pregnancy after Essure was approximately 23,725 days (65 years). Assuming CFR at 5.7%, livebirth delivery with total time missed from work at 65 days, this was associated with an aggregate economic impact of $49.2M in lost annual wages. Direct economic impact of unplanned pregnancy after Essure irrespective of outcome (terminations and deliveries) was estimated to result in US productivity losses valued at ~$130M. Although not all unplanned pregnancy costs are attributable to failed HS, estimates derived from earlier surveys have not considered this contraceptive method, and the economic consequences of unplanned pregnancy after Essure are not trivial. Quantifying the economic consequences of HS failure would be improved with specific ICD-10 coding for Essure-associated symptoms.