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

Figures & data

Box 1. Brands and characteristics of IUDs provided to EURAS-IUD study participants aged under 30.

IUD brand / name	Number provided	IUD type by copper surface area (mm^2)	IUD type by shape / design	IUD type by width (mm)	IUD type by IUD’s arms’ flexbility
Alphaload 375	48	300 - < 380	Ω	18- < 24	Yes, flex down
Ancora	7	Not specified	Ω	18 - < 24	Yes, flex down
Ancora 250/375	86	Not specified	Ω	18 - < 24	Yes, flex down
Ancora 375	1	300 - < 380	Ω	18 - < 24	Yes, flex down
Copper T 380	116	380	Not specified	≥30	Not specified
Cu safe	22	300 - < 380	T without arm bands	18 - < 24	Yes, flex down
Cu 300/375/380	2	Not specified	Not specified	Not specified	Not specified
Eve’s copper T 380 A/200 B	4	Not specified	T not specified	≥30	No
Femena/femena gold	193	300 - < 380	Ω	18 - < 24	Yes, flex down
Flexi T 300	57	300 - < 380	T without arm bands	18 - < 24	Yes, flex down
Flexi T 380	273	380	T with arm bands	24 - < 30	Yes, flex down
Gold T	12	300 - < 380	T without arm bands	Not specified	Yes, flex up
Goldlily 250	1	<300	T without arm bands	Not specified	Yes, flex up
Goldlily	8	Not specified	T without arm bands	Not specified	Yes, flex up
Gynefix 330	38	300 - < 380	Frameless	<18	Not applicable
Gynefix	54	Not specified	frameless	<18	Not applicable
Gyne T	5	380	T without arm bands	≥30	No
Gynetics Cu 375	5	300 - < 380	Ω	18 - < 24	Yes, flex down
Kupferspirale	1	Not specified	Not specified	Not specified	Not specified
Medusa 240	15	<300	Ω	18 - < 24	Yes, flex down
Mona Lisa	2	380	Not specified	≥30	Not specified
Multi safe 375	22	300 - < 380	Ω	18 - < 24	Yes, flex down
Multiload 250	9	<300	Ω	18 - < 24	Yes, flex down
Multiload 250/375	589	Not specified	Ω	18 - < 24	Yes, flex down
Multiload 375	68	300 - < 380	Ω	18 - < 24	Yes, flex down
Neo safe 380	84	380	T without arm bands	≥30	Yes, flex up
Nova T 200	328	<300	T without arm bands	≥30	Yes, flex up
Nova T 380	1902	380	T without arm bands	≥30	Yes, flex up
Novagard 200	1	<300	T without arm bands	≥30	Yes, flex up
Novaplus	29	380	T without arm bands	≥30	Yes, flex up
Optima IUD TCu 380 A	20	380	T with arm bands	≥30	No
Pregna copper-T 380 A	3	380	T with arm bands	≥30	No
SMB Cu 375	1	300 - < 380	Ω	18 - < 24	Yes, flex down
T 200/375/380	23	Not specified	Not specified	Not specified	Not specified
T de oro / T de plata	161	Not specified	T without arm bands	≥30	Yes, flex up
T safe 380	1287	380	T with arm bands	≥30	No
TT 380 slimline	275	380	T with arm bands	≥30	No
TT 380 active	10	380	T with arm bands	≥30	No
UT 380	32	380	T without arm bands	≥30	Yes, flex up
Yuan gong 300	1	300 - < 380	Y	Not specified	Not specified
Yunona bio-T Ag	1	Not specified	Y	Not specified	Not specified
Total	5796

Box 2. Factors and cost estimations as a consequence of IUD provision [5–8]

Outcome / unwanted effect included in costs	Associated resource use for outcome / unwanted effect [7,8]	Estimated minimum unit cost for element(s) of resource	Source of estimated minimum unit costs
IUD type	IUD type fitted in woman by HCP	Average price (£) of IUD brands in IUD type category	British National Formulary [7]
HCP visit	Consultation with a HCP ± investigations including ultrasound scan	£90	National Schedule of NHS Costs 2018/19 [5]
Expulsion	Consultation with a HCP ± IUD removal/ alternative method provision/ investigations including ultrasound scan	£90	National Schedule of NHS Costs 2018/19 [5]
Discontinuation	Consultation with a HCP ± IUD removal/ alternative method provision/ investigations including ultrasound scan	£90	National Schedule of NHS Costs 2018/19 [5]
Pregnancy	Consultation with a HCP ± IUD removal/ alternative method provision/ investigations including ultrasound scan/referral; medical termination of pregnancy	£419	Unit Costs of Health and Social Care 2019 [6]
Perforation	Consultation with a HCP ± IUD removal/ alternative method provision/ investigations including ultrasound scan or x-ray/ referral; laparoscopy to remove IUD	£752	National Schedule of NHS Costs 2018/19 [5] Unit Costs of Health and Social Care 2019 [6]

Figure 1. EURAS-IUD study participants aged under 30 provided copper intrauterine contraception (IUDs). *Participants could report more than one problem.

Table 1. Demographics and IUD types of EURAS-IUD participants aged under 30 at recruitment (N = 5796).

Demographic characteristics	Group	n	% of total sample
Age	18 − 19	323	5.6
	20 − 24	2008	34.6
	25 − 29	3465	59.8
Pregnancy history*	Never pregnant	1462	25.2
	Ever pregnant	4333	74.8
Birth history**	No previous (never) birth	496	11.5
	Previous (ever) birth	3837	88.5
Participant Country	Austria	512	8.8
	Finland	289	5.0
	Germany	1404	24.2
	Poland	234	4.0
	Sweden	745	12.9
	UK	2612	45.1
IUD type provided
Copper surface area	380mm^2	4038	69.7
	300mm^2-<380mm^2	469	8.1
	<300mm^2	354	6.1
	not specified	935	16.1
IUD shape / design	T with arm bands	1868	32.2
	T without arm bands	2642	45.6
	T not specified	122	2.1
	Ω	1044	18.0
	Frameless	92	1.6
	Y (ring)	2	0.0
	not specified	26	0.5
IUD width in mm	<18	92	1.6
	18 -< 24	1123	19.4
	24 -< 30	273	4.7
	≥30	4259	73.5
	Y / ring	2	0.0
	not specified	47	0.8
IUD’s arms’ flexibility***	Yes, flex up	2558	44.1
	Yes, flex down	1396	24.1
	None	1604	27.7
	not specified / applicable	238	4.1

*Pregnancy history not stated for 1 participant recruited in Finland.

**Total for birth history (n = 4333) is for participants who have ever been pregnant.

***not applicable to frameless and Y/ring IUDs.

Table 2. IUD continuation or use status at 1 year follow up* [%, (n)].

Characteristic	Groups	Using IUD	Not using IUD	p-value**
Age group N = 5762	18 − 19	87.6 (282)	12.4 (40)	0.016
	20 − 24	88.8 (1770)	11.2 (224)
	25 − 29	90.9 (3131)	9.1 (315)
Pregnancy history^ N = 5761	Never pregnant	89.7 (1307)	10.3 (150)	0.719
	Ever pregnant	90.0 (3875)	10.0 (429)
Birth history^^ n = 4304	No previous (never) birth	89.0 (439)	11.0 (54)	0.437
	Previous (ever) birth	90.2 (3436)	9.8 (375)
IUD type category***
Copper surface area (n = 4830)	380mm^2	89.3 (3580)	10.7 (429)	0.025
	300mm^2 -<380mm^2	91.7 (429)	8.3 (39)
	<300mm^2	93.2 (329)	6.8 (24)
IUD shape/design (n = 5612)	T with arm bands	88.1 (1636)	11.9 (221)	0.012
	T without arm bands	91.1 (2388)	8.9 (234)
	Ω	90.2 (939)	9.8 (102)
	Frameless	91.3 (84)	8.7 (8)
IUD width in mm (n = 5713)	<18	91.3 (84)	8.7 (8)	0.929
	18 -< 24	90.3 (1011)	9.7 (109)
	24 -< 30	90.0 (243)	10.0 (27)
	≥30	89.8 (3798)	10.2 (433)
IUD’s arms’ flexibility^^^ (n = 5524)	Yes, flex up	91.1 (2312)	8.9 (226)	0.002
	Yes, flex down	90.2 (1254)	9.8 (136)
	None	87.8 (1401)	12.2 (195)

*Total obtained after excluding participants who wished to conceive and with incomplete/unverified data.

**All p-values derived using Pearson Chi-square test after excluding Y/ring and non-specified IUD types.

***IUD categories shown excluding Y/ring and non-specified IUD types.

^Excludes 1 participant for whom pregnancy history not stated.

^^Total for birth history group at follow up (n = 4304) is for participants who were ever pregnant.

^^^not applicable to frameless and Y/ring IUDs.

Table 3. Unwanted effects including having to visit a HCP, expulsion and pregnancy at 1 year by IUD type.

IUD category	Group	Total at 1 year	Unwanted effects [%, (n)]	p-value^§	Worse bleeding [%, (n)]	p-value^§	Pain [%, (n)]	p-value^§	HCP visit [%, (n)]	p-value^§	Expulsion [%, (n)]	p-value^§	Pregnancy [%, (n)]	p-value^§
Copper surface area	380mm^2	4009	37.0 (1484)	0.000	20.0 (801)	0.000	18.2 (730)	0.003	25.8 (1036)	0.045	3.24 (130)	0.162	1.10 (44)	0.466
	300mm^2-< 380mm^2	468	32.9 (154)		17.1 (80)		15.2 (71)		25.4 (119)		2.99 (14)		1.71 (8)
	<300mm^2	353	26.6 (94)		11.3 (40)		11.6 (41)		19.8 (70)		1.42 (5)		1.42 (5)
IUD shape / design	T with arm bands	1857	37.1 (688)	0.001	20.4 (378)	0.001	18.0 (334)	0.000	27.3 (507)	0.043	4.15 (77)	0.002	1.18 (22)	0.644
	T without arm bands	2622	36.5 (958)		19.4 (508)		18.3 (480)		24.4 (639)		2.29 (60)		1.03 (27)
	Ω	1041	30.4 (316)		14.5 (151)		12.7 (132)		25.2 (262)		3.94 (41)		0.86 (9)
	Frameless	92	40.2 (37)		22.8 (21)		17.4 (16)		33.7 (31)		5.43 (5)		0 (0)
IUD width in mm	<18	92	40.2 (37)	0.000	22.8 (21)	0.000	17.4 (16)	0.000	33.7 (31)	0.047	5.43 (5)	0.377	0 (0)	0.627
	18 -< 24	1120	31.3 (350)		15.3 (171)		13.5 (151)		25.0 (280)		3.75 (42)		0.89 (10)
	24 -< 30	270	43.7 (118)		29.3 (79)		23.7 (64)		20.0 (54)		2.22 (6)		1.48 (4)
	≥30	4231	35.9 (1521)		19.0 (802)		17.4 (737)		25.9 (1094)		3.21 (136)		1.06 (45)
IUD’s arms’ flexibility*	Yes, flex up	2538	36.4 (923)	0.226	19.2 (488)	0.634	18.2 (461)	0.097	24.4 (620)	0.004	2.29 (58)	0.000	1.02 (26)	0.935
	Yes, flex down	1390	33.7 (468)		18.0 (250)		15.5 (215)		24.0 (334)		3.45 (48)		1.01 (14)
	None	1596	35.9 (573)		18.9 (301)		16.9 (270)		28.6 (456)		4.51 (72)		1.13 (18)

*not applicable to frameless and Y/ring IUDs.

^§p-values derived using Chi-square test and Fischer Exact test where applicable excluding Y/ring and non-specified IUD groups.

Table 4. Unwanted effects and incidence of visiting a HCP in those participants still using the IUD at 1 year by IUD type.

IUD category	Group	Total using IUD at 1 year	Unwanted effects [%, (n)]	p Value^§	Worse bleeding [%, (n)]	p Value^§	Pain [%, (n)]	p Value^§	HCP visit [%, (n)]	p Value^§
Copper surface area	380mm^2	3580	30.3 (1086)	0.002	18.0 (644)	0.004	16.3 (583)	0.016	17.0 (607)	0.230
	300mm^2 -<380mm^2	429	27.5 (118)		15.9 (68)		14.0 (60)		18.7 (80)
	<300mm^2	329	21.3 (70)		10.9 (36)		10.6 (35)		14.0 (46)
IUD shape / design	T with arm bands	1636	29.3 (479)	0.000	17.5 (286)	0.024	16.0 (261)	0.022	17.5 (286)	0.101
	T without arm bands	2388	31.1 (743)		18.1 (432)		16.5 (394)		17.0 (405)
	Ω	939	23.9 (224)		13.8 (130)		12.2 (115)		17.0 (160)
	Frameless	84	34.5 (29)		20.2 (17)		15.5 (13)		27.4 (23)
IUD width in mm	<18	84	34.5 (29)	0.000	20.2 (17)	0.000	15.5 (13)	0.004	27.4 (23)	0.006
	18 -< 24	1011	24.8 (251)		14.3 (145)		13.0 (131)		16.9 (171)
	24 -< 30	243	38.3 (93)		26.3 (64)		22.2 (54)		11.1 (27)
	≥30	3798	29.4 (1117)		17.1 (651)		15.5 (589)		17.4 (661)
IUD’s arms’ flexibility*	Yes, flex up	2312	31.0 (716)	0.031	18.0 (417)	0.245	16.3 (378)	0.306	17.0 (394)	0.149
	Yes, flex down	1254	27.4 (344)		16.7 (209)		14.8 (185)		15.8 (198)
	None	1401	27.7 (388)		16.0 (224)		14.8 (207)		18.6 (261)

*not applicable to frameless and Y/ring IUDs.

^§p Values derived using Chi-square test excluding Y/ring and non-specified IUD groups.

Table 5. Unwanted effects including having to visit a HCP in those participants not using the IUD at 1 year by IUD type.

IUD category	Group	Total not using IUD at 1 year	Unwanted effects [%, (n)]	p Value^§	Worse bleeding [%, (n)]	p Value^§	Pain [%, (n)]	p Value^§	Extra HCP visits^µ [%, (n)]	p Value^§
Copper surface area	380mm^2	429	92.8 (398)	0.390	36.6 (157)	0.115	34.3 (147)	0.502	0.47 (2)	0.067
	300mm^2-<380mm^2	34	92.3 (36)		30.8 (12)		28.2 (11)		0 (0)
	<300mm^2	24	100 (24)		16.7 (4)		25.0 (6)		4.17 (1)
IUD shape / design	T with arm bands	221	94.6 (209)	0.397	41.6 (92)	0.002	33.0 (73)	0.003	0.90 (2)	0.908
	T without arm bands	234	91.9 (215)		32.5 (76)		36.8 (86)		0.43 (1)
	Ω	102	90.2 (92)		20.6 (21)		16.7 (17)		0.98 (1)
	Frameless	8	100 (8)		50.0 (4)		37.5 (3)		0 (0)
IUD width in mm	<18	8	100 (8)	0.698	50.0 (4)	0.009	37.5 (3)	0.013	0 (0)	0.955
	18 -< 24	109	90.8 (99)		23.9 (26)		18.3 (20)		0.92 (1)
	24 -< 30	27	92.6 (25)		55.6 (15)		37.0 (10)		0 (0)
	≥30	433	93.3 (404)		34.9 (151)		34.2 (148)		0.69 (3)
IUD’s arms’ flexibility*	Yes, flex up	226	91.6 (207)	0.330	31.4 (71)	0.123	36.7 (83)	0.014	0.44 (1)	0.779
	Yes, flex down	136	91.2 (124)		30.1 (41)		22.1 (30)		0.74 (1)
	None	195	94.9 (185)		39.5 (77)		32.3 (63)		1.03 (2)

*not applicable to frameless and Y/ring IUDs.

§ p-values derived using Chi-square test and Fischer Exact test where applicable excluding Y/ring and non-specified IUD groups.

µ Extra HCP visits were HCP visits for unwanted effects excluding expulsion, discontinuation, pregnancy and perforation.

Table 6. Estimated cost consequences (£) at 1 year per 100 provisions by IUD type.

		Estimated costs (£) per 100 provisions
IUD category	Group	IUDs	Extra HCP visits	Discontinuation	Expulsions	Pregnancy	Perforation	Total
Copper surface area	380mm^2	1183	958.50	963.00	291.60	460.90	112.80	3969.80
	300mm^2-<380mm^2	918	1116.00	749.70	269.10	716.49	0	3769.29
	<300mm^2	918	917.10	612.00	127.80	594.98	0	3169.88
IUD shape / design	T with arm bands	1076	891.90	1071.00	373.50	494.42	120.32	4027.14
	T without arm bands	1327	1081.80	802.80	206.10	431.57	82.72	3931.99
	Ω	391	951.30	882.00	354.60	360.34	0	2939.24
	Frameless	2711	1761.30	783.00	488.70	0	0	5744.00
IUD width in mm	<18	2711	1761.30	783.00	488.70	0	0	5744.00
	18 -< 24	930	956.70	875.70	337.50	372.91	0	3472.81
	24 -< 30	947	567.00	900.00	199.80	620.12	0	3233.92
	≥30	1183	1009.80	920.70	288.90	444.14	105.28	3951.82
IUD’s arms’ flexibility*	Yes, flex up	1327	1089.00	801.00	206.10	427.38	90.24	3940.72
	Yes, flex down	933	881.10	880.20	310.50	423.19	0	3427.99
	None	1099	946.80	1099.80	405.90	473.47	142.88	4167.85

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