Cost-effectiveness analysis of levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg versus other long-acting reversible contraceptives for contraception in Spain

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.

SHORT CONDENSATION

Levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena^®) is an effective and cost-saving long-acting reversible contraceptive (LARC) method compared with other similar methods in Spain over an eight-year time horizon, and Kyleena^® was the most effective option.

Keywords:

• Long-acting reversible contraceptive
• cost-effectiveness
• contraception
• levonorgestrel-releasing intrauterine system
• LNG-IUS 52 mg
• unintended pregnancy

Acknowledgments

We thank Carla Arús, Maria Ruart, Marta Morros and Maite Artés from Adelphi Targis, S.L. for their contribution to the conceptualization, development and interpretation of the model, as well as for writing and editorial assistance. Writing and editorial assistance was provided by Adelphi Targis S.L. with funding from Bayer Hispania S.L.

Ethical approval

Ethics approval was not required for this study, not applicable.

Disclosure statement

J.C.Q. has received honoraria for consulting, participation on advisory boards or lecturing for Bayer Hispania, MSD, Gedeon Richter, Theramex, Exeltis, Astellas Pharma, Viñas and Organon outside the submitted work.

I.P.R has received honoraria for participation on advisory boards or lecturing for Bayer Hispania, MSD and Organon outside the submitted work.

J.P.C. has received honoraria for consulting, participation on advisory boards or lecturing for Bayer Hispania, MSD, Gedeon, Theramex, Exeltis, Gynea-Kern, Menarini, Cinfa and Organon outside the submitted work.

P.L.A. has received lecture fees and is a member of advisory boards and/or a consultant for Bayer, Exeltis, Gedeon Richter and Organon.

I.C. has received honoraria for participation in lecturing and publications for Bayer Hispania, Gedeon, Richter, Organon, Theramex and Fhering outside the submitted work.

M.A.G has received honoraria from Bayer, Gedeon Richter and Hologyc outside the submitted work.

J.G.A. has declared no potential conflicts of interest.

M.H.C. has received honoraria for consulting, participation on advisory boards or lecturing for Bayer Hispania, MSD, Gedeon, Exeltis, Dermofarm, Bial, Sysmex, Procare Health Iberia, Zambón and Organon outside the submitted work.

J.R.T is a full-time employee at Bayer Hispania S.L.

B.E.L is a full-time employee and minor shareholder of Bayer Hispania S.L.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.

Additional information

Funding

This analysis was sponsored and funded by Bayer Hispania S.L.