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LARC is a cost effective option

Obstetrics and gynaecology

Obstetrics and gynaecology

Contraceptive implants are highly cost effective when compared with oral contraception, a case-controlled retrospective study has shown.

The costs of providing a sub-dermal contraceptive implant and oral contraception were compared in a cohort of 493 users of each type of contraceptive method. The study was conducted over a period of 36 months in a community sexual reproductive health clinic in south east Wales.

The researchers included all relevant costs associated with providing each type of contraception. Direct costs included staff costs, equipment costs and drug costs. Indirect costs included pregnancy and outcome costs. However, capital costs, costs to the patient (eg travel to clinics) and additional visits outside the service were excluded. The annual costs and cumulative costs of each method were calculated.

Comparing the cost of each method per person per year, the contraceptive implant consistently cost less than oral contraception: £117.56 vs £356.88 at year 1, £70.9 vs £199.30 at year 2 and £47.21 vs £50.72 at year 3, respectively.

The same trend was seen when the cumulative cost per patient was compared over three years: £177.56 vs £356.88 at year 1, £80.96 vs £187.70 at year 2, and £50.30 vs £83.02 at year 3, for implants and oral contraception respectively.

Many of my peers in general practice tell me that some PCTs appear to be restricting the use of LARC solely on the basis of up-front costs. This seems to be divergent from the economic argument presented in the NICE guidance.1

This study supports the notion that LARC is more cost-effective than other methods. Commissioners should not take a short-term view when it comes to funding contraception.

Lipetz C, Phillips CJ, Fleming CF. The cost-effectiveness of a long-acting reversible contraceptive (Implanon®) relative to oral contraception in a community setting. Contraception 2009; 79: 304-309

Reviewer

Dr Richard Ma,
GP, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre

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