Skip to main content
Erschienen in: PharmacoEconomics 17/2004

01.12.2004 | Original Research Article

Relative cost effectiveness of Depo-Provera®, Implanon®, and Mirena® in reversible long-term hormonal contraception in the UK

verfasst von: Susan J. Varney, Julian F. Guest

Erschienen in: PharmacoEconomics | Ausgabe 17/2004

Einloggen, um Zugang zu erhalten

Abstract

Objective: To estimate the relative cost effectiveness for women aged ≥30 years, starting long-term hormonal contraception with either levonorgestrel intrauterine system (Mirena®), etonogestrel subdermal implant (Implanon®) or medroxyprogesterone acetate injection (Depo-Provera®).
Design and setting: This was a modelling study, performed from the perspective of the UK NHS, of contraceptive services supplied by a general practitioner.
Study participants and interventions: A dataset was created from the General Practice Research database (GPRD) comprising 16 835 women aged ≥30 years who received levonorgestrel intrauterine system (n = 6080), etonogestrel subdermal implant (n = 277) or medroxyprogesterone acetate injection (n = 10 478) for their long-term contraception between 1997 and 2002.
Methods: Contraception-related healthcare resource utilisation values and contraception continuation rates were obtained from the GPRD. The incidence of pregnancy associated with each contraceptive was obtained from the published literature. By combining the GPRD dataset with published clinical outcomes, a decision model was constructed. This was used to estimate the expected annualised direct healthcare costs and consequences of the provision of each type of contraception per woman-year in pounds sterling (£) at 2002/03 prices.
Results: Our model suggests that starting long-term contraception with levonorgestrel intrauterine system or etonogestrel subdermal implant instead of medroxyprogesterone acetate injection is a dominant strategy from the UK NHS perspective. In contrast, starting long-term contraception with etonogestrel subdermal implant instead of levonorgestrel intrauterine system is likely to be the least cost-effective option, since it would lead to an additional cost for each additional avoided pregnancy (£21 000).
Conclusion: Long-acting reversible hormonal contraception has the benefit of being extremely effective (>99%), and not reliant on patient compliance nor dependent on correct usage. The relative cost effectiveness of using any one contraceptive should be considered in the light of the additional clinical benefits it may confer, user acceptability, QOL, past medical history and the estimated cost of an unintended pregnancy. Choice of contraception is essential to meet diverse user needs and preferences that may change with the userfs stage of life. Only by offering choice will the maximum number of women be protected and therefore the greatest savings to the health service be gained.
Fußnoten
1
The use of trade names is for product identification purposes only and does not imply endorsement.
 
Literatur
1.
Zurück zum Zitat Department of Health. The national strategy for sexual health and HIV. London: Department of Health, 2001 Department of Health. The national strategy for sexual health and HIV. London: Department of Health, 2001
2.
Zurück zum Zitat Belfield T. The contraceptive decision: information and counselling. In: Kubba A, Sanfilippo J, Hampton N, editors. Contraception and office gynecology: choices in reproductive healthcare. London: WB Saunders, 1999 Belfield T. The contraceptive decision: information and counselling. In: Kubba A, Sanfilippo J, Hampton N, editors. Contraception and office gynecology: choices in reproductive healthcare. London: WB Saunders, 1999
3.
Zurück zum Zitat Walsh J, Lythgoe H, Peckham S. Contraceptive choices: supporting effective use of methods. London: Family Planning Association, 1996 Walsh J, Lythgoe H, Peckham S. Contraceptive choices: supporting effective use of methods. London: Family Planning Association, 1996
4.
Zurück zum Zitat Burkman R. Compliance and other issues in contraception. Int J Fertil Womens Med 1999; 44 (5): 234–40PubMed Burkman R. Compliance and other issues in contraception. Int J Fertil Womens Med 1999; 44 (5): 234–40PubMed
5.
Zurück zum Zitat Dawe F, Meltzer H. Contraception and sexual health, 2000. London: Office for National Statistics, 2002 Dawe F, Meltzer H. Contraception and sexual health, 2000. London: Office for National Statistics, 2002
6.
Zurück zum Zitat Business & Market Research Limited. Contraception survey of 1000 women in the UK. Burgess Hill: Schering Health Care Ltd, 2002. Report no.: 229/021 Business & Market Research Limited. Contraception survey of 1000 women in the UK. Burgess Hill: Schering Health Care Ltd, 2002. Report no.: 229/021
7.
Zurück zum Zitat Joint Formulary Committee. British national formulary. 44th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2003 Joint Formulary Committee. British national formulary. 44th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2003
8.
Zurück zum Zitat Glasier A, Gebbie A. Handbook of family planning and reproductive healthcare: reversibility and sterilisation. 4th ed. London: Churchill Livingstone/Harecourt, 2000: 192 Glasier A, Gebbie A. Handbook of family planning and reproductive healthcare: reversibility and sterilisation. 4th ed. London: Churchill Livingstone/Harecourt, 2000: 192
9.
Zurück zum Zitat Wood L, Coulson R. Revitalizing the general practice research database: plans, challenges, and opportunities. Pharmacoepidemiol Drug Saf 2001; 10: 379–83PubMedCrossRef Wood L, Coulson R. Revitalizing the general practice research database: plans, challenges, and opportunities. Pharmacoepidemiol Drug Saf 2001; 10: 379–83PubMedCrossRef
10.
Zurück zum Zitat Trussell J. Contraceptive failure. In: Hatcher RA, Trussell J, Stewart F, et al. Contraceptive technology: 18th rev. ed. New York: Ardent Media, 2002 Trussell J. Contraceptive failure. In: Hatcher RA, Trussell J, Stewart F, et al. Contraceptive technology: 18th rev. ed. New York: Ardent Media, 2002
11.
Zurück zum Zitat Croxatto JIB, Makarainen L. The pharmacodynamics and efficacy of implanon. Contraception 1998; 58: 91S–7SPubMedCrossRef Croxatto JIB, Makarainen L. The pharmacodynamics and efficacy of implanon. Contraception 1998; 58: 91S–7SPubMedCrossRef
12.
Zurück zum Zitat Phillips C. Economic analysis of long term reversible contraceptives: focus on implanon. Pharmacoeconomics 2000; 17 (2): 209–21PubMedCrossRef Phillips C. Economic analysis of long term reversible contraceptives: focus on implanon. Pharmacoeconomics 2000; 17 (2): 209–21PubMedCrossRef
13.
Zurück zum Zitat Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomised comparative trial. Contraception 1994; 49: 56–72PubMedCrossRef Andersson K, Odlind V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomised comparative trial. Contraception 1994; 49: 56–72PubMedCrossRef
14.
Zurück zum Zitat HM Treasury. The Green Book: appraisal and evaluation in central government. Norwich: The Stationary Office, 2003 HM Treasury. The Green Book: appraisal and evaluation in central government. Norwich: The Stationary Office, 2003
15.
Zurück zum Zitat Monthly Index of Medical Specialities (MIMS). London: Haymarket Medical Ltd, 2003 Feb Monthly Index of Medical Specialities (MIMS). London: Haymarket Medical Ltd, 2003 Feb
16.
Zurück zum Zitat Netton A, Dennett J, Knight J. Unit cost of health and social care 2002. Canterbury: University of Kent, Personal Social Services Research Unit, 2002 Netton A, Dennett J, Knight J. Unit cost of health and social care 2002. Canterbury: University of Kent, Personal Social Services Research Unit, 2002
17.
Zurück zum Zitat McGuire A, Hughs D. The cost-effectiveness of family planning service provision. J Public Health Med 1996; 187 (2): 189–96 McGuire A, Hughs D. The cost-effectiveness of family planning service provision. J Public Health Med 1996; 187 (2): 189–96
19.
Zurück zum Zitat Lahteenmaki P, Haukkamaa M, Puolakka J, et al. Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. BMJ 1998; 316 (7138): 1122–6PubMedCrossRef Lahteenmaki P, Haukkamaa M, Puolakka J, et al. Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. BMJ 1998; 316 (7138): 1122–6PubMedCrossRef
20.
Zurück zum Zitat Irvine GA, Campbell-Brown MB, Lumsden MA, et al. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol 1998; 105: 592–8PubMedCrossRef Irvine GA, Campbell-Brown MB, Lumsden MA, et al. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol 1998; 105: 592–8PubMedCrossRef
21.
Zurück zum Zitat National Institute for Clinical Excellence. Final scope for clinical guideline on: long-acting reversible contraception: the effective and appropriate use of long-acting reversible contra ception [online]. Available from URL: http://www.nice.org.uk [Accessed 2003 May 1] National Institute for Clinical Excellence. Final scope for clinical guideline on: long-acting reversible contraception: the effective and appropriate use of long-acting reversible contra ception [online]. Available from URL: http://​www.​nice.​org.​uk [Accessed 2003 May 1]
22.
Zurück zum Zitat Trussell J, Leveque JA, Koenig JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995; 85 (4): 494–503PubMedCrossRef Trussell J, Leveque JA, Koenig JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health 1995; 85 (4): 494–503PubMedCrossRef
23.
Zurück zum Zitat ABPI compendium of data sheets and summaries of product characteristics 2001–2002. London: Association of the British Pharmaceutical Industries, 2001 ABPI compendium of data sheets and summaries of product characteristics 2001–2002. London: Association of the British Pharmaceutical Industries, 2001
24.
Zurück zum Zitat Wirthlin Europe Limited. Women’s contraception survey in 2500 UK subjects. Stockport: Schering Health Care Ltd, 2003 Apr. Report no. 425021 Wirthlin Europe Limited. Women’s contraception survey in 2500 UK subjects. Stockport: Schering Health Care Ltd, 2003 Apr. Report no. 425021
Metadaten
Titel
Relative cost effectiveness of Depo-Provera®, Implanon®, and Mirena® in reversible long-term hormonal contraception in the UK
verfasst von
Susan J. Varney
Julian F. Guest
Publikationsdatum
01.12.2004
Verlag
Springer International Publishing
Erschienen in
PharmacoEconomics / Ausgabe 17/2004
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200422170-00004

Weitere Artikel der Ausgabe 17/2004

PharmacoEconomics 17/2004 Zur Ausgabe