The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline

Hum Reprod. 2008 Jun;23(6):1338-45. doi: 10.1093/humrep/den091. Epub 2008 Mar 26.


Background: Long-acting reversible contraceptive (LARC) methods are highly effective in preventing unintended pregnancies. However, their uptake is low in much of the developed world. This study aimed at assessing the cost-effectiveness of LARC methods from the British National Health Service (NHS) perspective.

Methods: A decision-analytic model was constructed to estimate the relative cost-effectiveness of the copper intrauterine device (IUD), the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant and the depot medroxyprogesterone acetate injection (DMPA). Comparisons with the combined oral contraceptive pill (COC) and female sterilization were also performed. Effectiveness data were derived from a systematic literature review. Costs were based on UK national sources and expert opinion.

Results: LARC methods dominated COC (i.e. they were more effective and less costly). Female sterilization dominated LARC methods beyond 5 years of contraceptive protection. DMPA and LNG-IUS were the least cost-effective LARC methods. The incremental cost-effectiveness ratio of implant (most effective LARC method) versus IUD (cheapest LARC method) was pound13 206 per unintended pregnancy averted for 1 year of use and decreased until implant dominated IUD in 15 years. Discontinuation was a key determinant of the cost-effectiveness of LARC methods.

Conclusions: LARC methods are cost-effective from the British NHS perspective. Practices improving user satisfaction and continuation of LARC method use should be identified and promoted.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Contraception / economics*
  • Contraceptive Agents, Female / administration & dosage*
  • Contraceptive Agents, Female / economics*
  • Contraceptives, Oral / economics
  • Cost-Benefit Analysis
  • Decision Trees
  • Desogestrel / administration & dosage
  • Desogestrel / economics
  • Drug Administration Routes
  • Drug Implants / economics
  • Female
  • Humans
  • Intrauterine Devices, Copper / economics
  • Levonorgestrel / administration & dosage
  • Levonorgestrel / economics
  • Medroxyprogesterone / administration & dosage
  • Medroxyprogesterone / economics
  • Models, Theoretical
  • Practice Guidelines as Topic*
  • Sterilization, Tubal / economics
  • Time Factors
  • United Kingdom


  • Contraceptive Agents, Female
  • Contraceptives, Oral
  • Drug Implants
  • etonogestrel
  • Levonorgestrel
  • Desogestrel
  • Medroxyprogesterone