Efficiency of the use of long-acting reversible contraception: a systematic review of the literature

Gomez de la Rosa, F | 2018

Objectives To develop a systematic review of economic evaluations on the use of long-acting reversible contraceptives (LARC). Methods A systematic review of scientific literature was carried out in Pubmed, Chochrane and Google Scholar databases. Economic evaluations and systematic reviews of the literature that included long-acting contraception methods (LARC) as intervention technology were included. The review was made in English and Spanish. No publication date restriction were applied on the selected studies. Quality assessment was developed using the CHEERS verification list (Consolidated Health Economic Evaluation Reporting Standards) developed by the ISPOR guidelines (International Society for Pharmacoeconomics and Outcomes Research). Results After applying the inclusion criteria, thirteen studies were included (ten cost-effectiveness analyzes, one cost-utility study, one cost-benefit study, and one unspecified economic evaluation). All the studies involved women in reproductive age (15-49 years). Nine studies used a Markov model to simulate the use of contraceptives. The main clinical outcome was the number of unwanted pregnancies. 84% (11) of studies resulted in cost savings with the evaluated LARC intervention. The remaining studies could not reach the CE threshold mostly due to the intervention price was not competitive. LARC costs vary significantly by type and country. The most cost effective ones resulted to be levonorgestrel (LGN 20 IUS), T380A copper IDU, Implanon and the YuangongCu365. Regarding quality, 77% of the studies analyzed costs from the third payer perspective. In addition, the majority of studies (70%) meet barely 56% of the items included in the CHEERS list. Conclusions Most studies reported dominance in long-term contraceptive methods when considering time horizons of more than 24 months, resulting in cost savings for the health systems even when administration and insertion of long-term methods is more costly at beginning of planning.