The Cost Effectiveness of LARCs

Paul Nolan

Despite the myths to the contrary, In addition to their numerous other benefits, Long-Acting Reversible Contraceptives (LARCs) are highly cost-effective in the long-run...

Long-Acting Reversible Contraceptives (LARCs) are a great option for women who have busy lives, filled with work, play or travel. There are many acknowledged benefits to using LARCs. These include the following:

• LARCs are one of the most reliable types of contraception, as they are over 99% effective;

• LARCs are also highly convenient as you don’t have to worry about remembering to take them every day;

• LARCs can be used for a long time, but can be discontinued at any stage with no delay in return to fertility (an exception can be the injection).

THE COST

There is a higher up-front cost with LARCs, compared to other methods such as oral contraceptive pills. This can be off-puting at first. However, the long-lasting nature of LARCs makes that initial outlay more than well worthwhile: in addition to being long-lasting and convenient, for up to a ten-year period, using LARCs can result in significant savings compared to birth control pills and condoms.

Indeed, on top of these general long-term savings in contraceptive cost, a proportion of women switching from short-acting contraceptives to long-acting will also generate considerable savings, where unplanned pregnancy-related expenses would otherwise kick in.

To put that in perspective, a 2012 US study ("Effectiveness of Long Acting Reversible Contraception", New England Journal of Medicine), with the largest cohort of IUC and implant users to date, found that the risk of contraceptive failure for those using oral contraceptive pills, the birth control patch, or the ring was all of 17 to 20 times higher than the risk for those using long-acting reversible contraception. It is a remarkable statistic, which points to the benefits that LARCs offer to young women who enjoy an active sex life.

THE LARC OPTIONS

1. Intrauterine system (IUS)

This is a plastic T-shaped device which lasts for up to five years. It releases daily small doses of a progestogen hormone called levonorgestrel directly into the womb. It can be used during breastfeeding. Your periods usually become much lighter and shorter, and sometimes less painful. They may stop completely after the first year of use. It can also be used as a treatment for heavy periods. Fertility returns immediately after removal of the IUS.

2. The intrauterine device (IUD) or copper coil also provides a reliable long-term option. It can be used for five to ten years. (It can also be used as an emergency contraceptive for up to 5 days after unprotected intercourse). A doctor or nurse will take a few minutes to put the IUD in place. Like the intrauterine system (IUS), the coil can be removed at any time, and fertility will return immediately.

3. The contraceptive injection, which contains progestogen-only, is a long-acting hormonal method, which lasts for three months at a time. The injections are suitable for women who are breast-feeding, and also for those who do not tolerate estrogen. The contraceptive injection has very high reliability when used properly. It may take months for fertility to return.

4. A contraceptive implant is a small, flexible plastic rod, containing a progestogen hormone called etonogestrel, which is inserted in your upper arm by a minor surgical procedure. The progestogen is released in tiny doses and the implant prevents pregnancy for three years. It can be removed at any time by minor surgery. It may take months for fertility to return.

LARCs – THE US EXPERIENCE

From an Irish perspective, it is interesting to observe how LARCs are constantly growing in popularity in the US. A program geared toward increasing the use of LARC among adolescents in Iowa (University of Iowa Public Policy Centre) demonstrated a significant decrease in the unintended pregnancy and abortion rate in that State, along with a projected savings of $17.23 for every dollar spent on contraception. Similarly, in Colorado, a six-year programme funded by a private grant, decreased unplanned adolescent pregnancies in the State by about 40% and returned $5 in savings for each dollar spent.

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