Copper IUD continuation, unwanted effects and cost consequences at 1 year in users aged under 30 – a secondary analysis of the EURAS-IUD study

Abstract

Objective

To conduct a secondary analysis of continuation, unwanted effects and cost consequences at 1 year in copper intrauterine device (IUD) users aged under 30 in the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD study) based on IUD type.

Methods

Descriptive and comparative analyses of copper IUD continuation, unwanted effects and estimated cost consequences at 1 year were performed in users aged under 30 based on IUD copper surface area, shape or design, width and arms’ flexibility.

Results

5796 copper IUD users were identified to have been aged under 30 at EURAS-IUD study recruitment and data for 5762 users (99.4%) was analysed. Higher IUD continuation, fewer unwanted effects and lower costs were observed with IUDs of the lowest copper content (<300mm²), horse-shoe frame design, widths 18 mm to <30mm and flexible IUD arms. Discontinuation, unwanted effects and costs were greater with frameless IUDs and framed, ≥30mm width IUDs with 380mm² of copper and copper bands on their rigid transverse IUD arms.

Conclusions

Significant differences in continuation, reported unwanted effects and estimated costs at 1 year between IUD types were observed in users aged under 30. Although further research is needed, clinicians should consider these findings when counselling and choosing IUD types for younger women.

摘要

目的：根据宫内节育器（intrauterine device, IUD）类型, 对欧洲IUD主动监测研究（EURAS-IUD研究）中30岁以下的带铜IUD使用者1年内的使用持续性、不良反应和成本后果进行二次分析。

方法：根据带铜IUD的铜表面积、形状或设计、宽度和臂的灵活性, 对30岁以下的使用者1年内的使用持续性、不良反应和费用进行描述性和对比分析。

结果：在EURAS-IUD研究中, 发现5796名带铜IUD使用者年龄在30岁以下, 并对5762名使用者（99.4%）的数据进行了分析。使用铜含量最低（<300mm²）、马蹄形设计、宽度18 mm至小于30 mm和臂灵活的IUD, 使用的持续性较长、不良反应较少, 费用也较低。无框IUD, 带框、宽度≥30 mm、有380 mm²铜的IUD, 以及刚性横臂上有铜环的IUD, 停用率、不良影响和成本更高。

结论：30岁以下的IUD使用者在持续使用性、报告的不良反应和1年的费用方面存在显著差异。尽管需要进一步研究, 但临床医生在为年轻女性提供咨询和选择IUD类型时应考虑这些发现。

Keywords:

• Copper intrauterine device
• IUD
• continuation
• costs
• younger women

Acknowledgments

We are grateful to: EURAS-IUD study sponsor and researchers Bayer PLC and ZEG Berlin respectively for permissions and providing a subset of the EURAS-IUD study data; Senior Health Economists Ifigeneia Mavranezouli of the University College London/RCOG National Guideline Alliance and Stephen Rice of Newcastle University for their professional advice; and ZEG Berlin’s EURAS-IUD study team and Emeritus Professor John Guillebaud for their valuable comments on the paper.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the British Medical Association’s Foundation for Medical Research in the form of a Lift into Research 2019 grant.