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.

Keywords: LNG-IUS 52 mg; Long-acting reversible contraceptive; contraception; cost-effectiveness; levonorgestrel-releasing intrauterine system; unintended pregnancy.