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Hum. Reprod. Advance Access originally published online on March 26, 2008
Human Reproduction 2008 23(6):1338-1345; doi:10.1093/humrep/den091
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline

I. Mavranezouli on behalf of the LARC Guideline Development Group1

National Collaborating Centre for Women's and Children's Health (NCC-WCH), Royal College of Obstetricians and Gynaecologists, London, UK

1 Correspondence address. National Collaborating Centre for Mental Health (NCC-MH), Centre for Outcomes Research and Effectiveness Sub department of Clinical Health Psychology, University College London, 1–19 Torrington Place, London WC1E 7HB, UK. Tel: +44-207-679-1979; Fax: +44-207-91-68-511; E-mail: i.mavranezouli{at}ucl.ac.uk

BACKGROUND: Long-acting reversible contraceptive (LARC) methods are highly effective in preventing unintended pregnancies. However, their uptake is low in much of the developed world. This study aimed at assessing the cost-effectiveness of LARC methods from the British National Health Service (NHS) perspective.

METHODS: A decision-analytic model was constructed to estimate the relative cost-effectiveness of the copper intrauterine device (IUD), the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant and the depot medroxyprogesterone acetate injection (DMPA). Comparisons with the combined oral contraceptive pill (COC) and female sterilization were also performed. Effectiveness data were derived from a systematic literature review. Costs were based on UK national sources and expert opinion.

RESULTS: LARC methods dominated COC (i.e. they were more effective and less costly). Female sterilization dominated LARC methods beyond 5 years of contraceptive protection. DMPA and LNG-IUS were the least cost-effective LARC methods. The incremental cost-effectiveness ratio of implant (most effective LARC method) versus IUD (cheapest LARC method) was £13 206 per unintended pregnancy averted for 1 year of use and decreased until implant dominated IUD in 15 years. Discontinuation was a key determinant of the cost-effectiveness of LARC methods.

CONCLUSIONS: LARC methods are cost-effective from the British NHS perspective. Practices improving user satisfaction and continuation of LARC method use should be identified and promoted.

Key words: long-acting reversible contraception/cost-effectiveness/discontinuation/economic modelling

Submitted on December 5, 2007; resubmitted on February 14, 2008; accepted on February 29, 2008.


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