1
|
Conde JCQ, Parra Ribes I, Perelló-Capo J, Lobo Abascal P, García IC, Andeyro García M, Gutiérrez Alés J, Herrero Conde M, Rius Tarruella J, Espinós Lafuente B. Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg versus other long-acting reversible contraceptives for contraception in Spain. EUR J CONTRACEP REPR 2024; 29:224-232. [PMID: 38989683 DOI: 10.1080/13625187.2024.2369843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/14/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Condoms and combined oral contraceptive pills are widely used in Spain with high failure rates. Long-Acting Reversible Contraceptive (LARC) methods offer better efficacy and adherence and reduce unintended pregnancies (UP) compared with short-acting reversible contraceptive (SARC) methods. OBJECTIVE To assess the cost-effectiveness of LNG-IUS 52 mg (Mirena®) versus other LARC for contraception in Spain. MATERIALS AND METHODS A Markov model with annual cycles and an eight-year time horizon was developed from the Spanish national healthcare system (NHS) perspective, considering costs for contraceptive method acquisition, health care resources (HCR) and UP. Effectiveness was based on failure and discontinuation rates. Sensitivity analyses were performed to test the model's robustness. RESULTS LNG-IUS 52 mg (Mirena®) resulted in lower costs and fewer UP versus LNG-IUS 13.5 mg (Jaydess®), Implant (Implanon®) and Copper IUD. LNG-IUS 52 mg (Levosert®) prevented the same UP events at a higher cost. LNG-IUS 19.5 mg (Kyleena®) was the most effective option, due to a lower discontinuation rate. CONCLUSIONS LNG-IUS 52 mg (Mirena®) is the least costly LARC, driven by lower acquisition costs and reduced HCR utilisation. Increasing LNG-IUS 52 mg (Mirena®) uptake in contraception could generate further cost savings for the Spanish NHS and reduce economic burden of UP.
Collapse
Affiliation(s)
- José C Quílez Conde
- President of the Spanish Society of Contraception (SEC), 2022 - 2024. Servicio Ginecología y Obstetricia, Hospital Universitario de Basurto, Bilbao, Spain
| | - Inmaculada Parra Ribes
- Unidad de Salud Sexual y Reproductiva de Sueca, Hospital Universitario de "La Ribera". Consejería Valenciana de Sanidad, Valencia, Spain
| | - Josep Perelló-Capo
- Servicio de Ginecología y Obstetricia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paloma Lobo Abascal
- Servicio de Ginecología y Obstetricia, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
- Universidad Europea, Madrid, Spain
| | - Ignacio Cristóbal García
- Servicio de Ginecología y Obstetricia, Hospital Clínico San Carlos, Universidad Francisco de Vitoria, Madrid, Spain
| | - Mercedes Andeyro García
- Head of Servicio de Ginecología y Obstetricia, Hospital Universitario General de Villalba, Madrid, Spain
- Universidad Alfonso X El Sabio, Madrid, Spain
| | | | | | | | | |
Collapse
|
2
|
Obafemi OA, Leichliter JS, Maravi M, Alfonsi GA, Shlay JC, Wendel KA, Rietmeijer CA. Successful Provision of Long-Acting Reversible Contraception in a Sexual Health Clinic. Sex Transm Dis 2022; 49:443-447. [PMID: 35608098 PMCID: PMC9951185 DOI: 10.1097/olq.0000000000001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women who attend sexual health clinics are at high risk for sexually transmitted infections and unintended pregnancy. Long-acting reversible contraceptives (LARC) are very effective contraceptive methods, but the provision of LARC in such clinics is not well described in the literature. METHODS We conducted a retrospective chart review of women who presented to Denver Sexual Health Clinic for any reason and received family planning services between April 1, 2016, and October 31, 2018. We assessed demographic and clinical factors associated with contraceptive method received and conducted a subanalysis of those with intrauterine device (IUD) insertions on the same-day versus delayed insertion. Among those who received an IUD, we assessed rates of pelvic inflammatory disease (PID) 30 days after insertion. RESULTS Of the 5064 women who received family planning services in our clinic, 1167 (23%) were using a LARC method at the time of their visit. Of the 3897 who were not using a LARC, fewer women, 12.6%, chose LARC (IUD and progestin implant), compared with 33.3% who chose new short-acting reversible contraceptives. Further analysis of the 270 IUD initiators revealed 202 (74.8%) received the IUD on the same day, whereas 68 (25.2%) had delayed IUD insertion. There were 9 incident cases of gonorrhea or chlamydia in those who received same-day IUD and 1 incident case among those who had delayed IUD insertion. There were no cases of PID at 30 days after insertion in either group. CONCLUSIONS Study findings support IUD provision in a sexual health clinic on the day of initial visit without increased risk of PID.
Collapse
Affiliation(s)
- Oluyomi A. Obafemi
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Grace A. Alfonsi
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver
| | - Judith C. Shlay
- Public Health Institute at Denver Health, Denver
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver
| | - Karen A. Wendel
- Public Health Institute at Denver Health, Denver
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora
| | | |
Collapse
|
3
|
El Ayadi AM, Rocca CH, Averbach SH, Goodman S, Darney PD, Patel A, Harper CC. Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial. J Pediatr Adolesc Gynecol 2021; 34:355-361. [PMID: 33276125 PMCID: PMC8096684 DOI: 10.1016/j.jpag.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. DESIGN Secondary analysis of a cluster-randomized provider educational trial. SETTING Forty US-based reproductive health centers. PARTICIPANTS We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. INTERVENTIONS The parent study assessed the effect of provider training on evidence-based contraceptive counseling. MAIN OUTCOME MEASURES We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. RESULTS Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). CONCLUSION In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.
Collapse
Affiliation(s)
- Alison M El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Sarah H Averbach
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, California
| | - Suzan Goodman
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Philip D Darney
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Ashlesha Patel
- Planned Parenthood Federation of America, New York, New York
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| |
Collapse
|
4
|
Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. Background review for the '2020 European guideline for the diagnosis and treatment of gonorrhoea in adults'. Int J STD AIDS 2020; 32:108-126. [PMID: 33323071 DOI: 10.1177/0956462420948739] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
Collapse
Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
5
|
Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020:956462420949126. [PMID: 33121366 DOI: 10.1177/0956462420949126] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. For detailed background, evidence base and discussions, see the background review for the present 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
Collapse
Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
6
|
Apter D. Contraception options: Aspects unique to adolescent and young adult. Best Pract Res Clin Obstet Gynaecol 2017; 48:115-127. [PMID: 29032945 DOI: 10.1016/j.bpobgyn.2017.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022]
Abstract
Sexual health for adolescents is based on three components: recognizing sexual rights, sexuality education and counseling, and thirdly confidential high quality services. Contraception needs to include prevention of both STIs and pregnancies. The first option for adolescents is condoms backed-up by emergency contraception; and later hormonal contraceptives in a longer, mutually monogamous relationship. Condoms and hormonal contraception together can be well recommended for adolescents for dual protection. Long acting reversible contraception (LARC) including both intrauterine contraception and implants are safe and highly effective and thus well suited for adolescents. Improved contraceptive methods do not automatically lead to reduced numbers of adolescent abortions. When sexuality education, proper counseling and sexual health services are all provided, it is possible to profoundly improve adolescent sexual health.
Collapse
Affiliation(s)
- Dan Apter
- VL-Medi Clinical Research Center, Töölönkatu 37 B, 00260, Helsinki, Finland.
| |
Collapse
|
7
|
Postabortion Initiation of Long-Acting Reversible Contraception by Adolescent and Nulliparous Women in New Zealand. J Adolesc Health 2016; 58:160-6. [PMID: 26603946 DOI: 10.1016/j.jadohealth.2015.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/24/2015] [Accepted: 09/26/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe changes in receipt of immediate postabortion long-acting reversible contraception (LARC) by adolescent and nulliparous women in New Zealand. METHODS Nationally collected data on immediate postabortion receipt of an intrauterine method (intrauterine device [IUD]/intrauterine system [IUS]) or contraceptive implant were analyzed to describe proportions and demographic characteristics of women receiving LARC between 2007 and 2013. Changes in uptake over time were presented for adolescent, nulliparous, and parous women. RESULTS Postabortion LARC uptake increased between 2007 and 2013, rising from 7.9% to 42.7% for adolescents and from 8.8% to 36.9% for nulliparous women. The increase was highest among nulliparous adolescents with a seven-fold increase in LARC uptake between 2007 and 2013. Adolescents had a five-fold increase and nulliparous women (of all ages) a four-fold increase. In 2013, IUD/IUS use was lowest among adolescents (22.4%) and increased with increasing age (43% by ages 40+ years), whereas implant use was highest among adolescents (20.3%) and decreased with increasing age (to 4.6% by age 40+ years). Nulliparous women had the lowest use of both IUD/IUS and implants in 2013, with 24.6% receiving an intrauterine method (compared with 43.2% for para 3+), and 12.3% an implant (compared with 17.5% for para 3+). CONCLUSIONS Despite an overall trend toward increased uptake of postabortion LARC by adolescent and nulliparous women, uptake in these groups still lags behind that of parous and older women. Reasons for differential uptake need to be explored and addressed if necessary to ensure all women have equitable access to the most effective methods of contraception.
Collapse
|
8
|
Abstract
Intrauterine devices (IUDs) are effective, reversible forms of contraception with high patient satisfaction and continuation. IUDs can be safely used by most women and should be considered the first-line method of contraception for all women. This descriptive review will discuss the clinical issues associated with IUDs - including management of side effects, noncontraceptive uses and insertion and removal. When the burdens of cost are removed, women are more likely to select and IUDs. Health policy changes that increase insurance coverage for contraception will improve access to IUDs. IUDs remain an underutilized form of contraception in USA and efforts to improve availability and access to long-acting reversible contraception methods is needed to optimize their use.
Collapse
Affiliation(s)
- Natalie S Whaley
- Department of Obsetrics & Gynecology, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 668, Rochester, NY 14642, USA
| | - Anne E Burke
- Department of Gynecology & Obstetrics, Johns Hopkins University, 4240 Eastern Avenue, Baltimore, MD 21224, USA
| |
Collapse
|
9
|
Sufrin C, Oxnard T, Goldenson J, Simonson K, Jackson A. Long-Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On-Site Provision. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:203-211. [PMID: 26484795 DOI: 10.1363/47e5915] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods--IUDs and implants--before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described. METHODS A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses. RESULTS Eighty-seven LARC devices were inserted during the study period--53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4). CONCLUSIONS It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.
Collapse
Affiliation(s)
- Carolyn Sufrin
- Assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore.
| | - Tianyi Oxnard
- Student at the School of Medicine, University of California, San Francisco
| | - Joe Goldenson
- Director, Jail Health Services, San Francisco Department of Public Health
| | - Kristin Simonson
- Assistant director of program management, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Andrea Jackson
- Assistant professor, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| |
Collapse
|
10
|
California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision. Obstet Gynecol 2015; 126:338-345. [DOI: 10.1097/aog.0000000000000969] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|