Bringing more evidence into contraceptive counseling: Building a new provider tool to tailor predictions of contraceptive outcomes to patient sub-populations
Awarded 2014
Large Research Grants
Caroline Moreau, MD, PhD, MPH
Johns Hopkins University

Objectives: to review the literature to quantify the risk of major adverse events linked to contraceptive methods and pregnancy; to supplement these findings using analyses from a large insurance claims database; to create a Markov model predicting risk of adverse events, and to develop a prototype smartphone app as a prototype that could serve as a decision tool for clinical practice. Methods: We conducted a literature review to synthesize data on probabilities of major health concerns associated with use of contraception. We then used the Maryland Claims Database to estimate method-specific incidence rates of pregnancy-related and contraceptive-related complications for subgroups of women of reproductive age. We synthesized results to generate a Markov model, which informed development of a pilot interactive App. Results: Our results display one-year incidences of five serious health events (myocardial infarction, stroke, venous thrombosis, pelvic inflammatory disease and ectopic pregnancy) according to use of specific contraceptive methods, including complications resulting from pregnancy in case of non-use or method failure. These incidences, expressed per 100,000 woman years, vary by woman’s age and cardiovascular risk factors (obesity, hypertension, and smoking behavior). Conclusions: Limitations of study designs contribute to knowledge gaps in existing literature. Claims data offer alternative methodology to assess the relationship of contraceptive use and health outcomes, though these are limited by reliance on coding. Our approach utilizing literature synthesis and claims data helped to inform development of prototype app to incorporate consideration of risk into contraceptive decision-making.