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

OBJECTIVE To estimate the relative cost effectiveness for women aged > or =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 > or =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 (pound) 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 (pound 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 user's 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.