title: What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting?
abstract: BACKGROUND
  The anticipated increase in uptake of intrauterine system (IUS) fittings is slower than predicted by the National Institute for Health and Clinical Excellence (NICE). There is evidence to suggest that this is because of a high perceived cost of providing this contraceptive method. Whereas studies to date have all guessed at these costs, we calculated the actual costs of providing the IUS.
  
  
  METHODS
  We tracked the notes of 283 women who had an IUS fitted in our community sexual and reproductive health service for 5&emsp14;years. We recorded duration of use, measured the actual cost of all appointments and interventions over the lifespan of the device, and compared our findings with NICE predicted costs.
  
  
  RESULTS
  With 70% complete follow-up, the average duration of use of the IUS was 3.44&emsp14;years compared to NICE's prediction of 3.32. The average annual cost of providing an IUS for contraception in community clinics was £54.55 per woman; this compares with £70.49 modelled by NICE for provision in primary care. Most (80%) of the cost is incurred in the first year. The cost of managing problems is small.
  
  
  CONCLUSIONS
  Providing the IUS for contraception was 23% cheaper in the present study than that predicted by NICE and cheaper than providing combined oral contraception in our service. Fitting IUSs in community clinics may be cheaper than in primary care. Streamlining the patient pathway will reduce costs further. Restricting access to the IUS because of initial cost is a false economy.
authors.affiliation: Associate Specialist, Aneurin Bevan Health Board - Sexual and Reproductive Healthcare, Llanfrechfa Grange Hospital, Gwent, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Cook
authors.forename: Charlotte
authors.initials: C
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003153:Community Health Services / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000191:economics*; D011247:Pregnancy; D011320:Primary Health Care / Q000191:economics*; D011446:Prospective Studies; D034121:Reproductive Health Services / Q000191:economics*; D006113:United Kingdom; D055815:Young Adult
keywords: family planning service provision; health economics; intrauterine systems; long-acting reversible contraception; service delivery