Tag Archives: IUD

IUD Contraception Cost May Inhibit Use

A copper intrauterine device (IUD) retails for the equivalent of $20 in France. In the United States, it costs $860, Dr. Eve Espey says.

“This is highway robbery. It has to change,” she said during a talk on long-acting reversible contraception at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). “Honestly,” she sighed, “If you went to Home Depot and picked up the supplies to make yourself an IUD, what would it cost? Like, under $1.” (Not that she’s advocating that.)

Dr. Eve Espey (Sherry Boschert/IMNG Medical Media)

Strong words, and they’re not coming from just any frustrated physician. Dr. Espey is chair of ACOG’s Working Group on Long-Acting Reversible Contraception and a professor of ob.gyn. at the University of New Mexico, Albuquerque.

The high U.S. price may be one reason that only 6% of U.S. women using contraceptives choose an IUD, even though studies show it’s one of the most effective kinds of contraception, along with levonorgestrel intrauterine systems and contraceptive implants, the other two kinds of long-active reversible contraceptives.

Sure, the cost of a copper IUD may be somewhat less than $860 if the physician or patient has access to government prices or other discounts, but it still creates a financial burden for physicians to stock their shelves with IUDs, not to mention inadequate reimbursement from insurers, she said.

“I think that the emerging, biggest barrier to IUD and implant use in this country is price,” Dr. Espey said. “ACOG is really trying to work to make a dent in that, but I think that until we see a cheaper IUD, it’s going to be a barrier to increased usage.”

Dr. Espey reported having no financial disclosures.

There’s only one copper IUD approved for use in the United States, so I contacted the makers of the ParaGard IUD, Teva Women’s Health. The “typical cost” for one ParaGard is $754, according to the company’s vice president for corporate communications, Denise Bradley. She said that the ParaGard’s price is “below most other forms of female birth control,” that most insurance plans cover ParaGard, and that the company offers women whose insurers don’t cover the IUD the option of paying by monthly installments.

She didn’t respond directly to the question of whether ParaGard’s cost is a barrier to use, but said, “Teva Women’s Health believes that increased access to all forms of contraception is of critical importance to all women of reproductive age.” She declined to comment on price differences between copper IUDs in the United States and other countries.

Recent data show that when financial barriers are removed and women receive standardized information about contraceptive choices, many more choose long-acting reversible contraception. The Reproductive CHOICE Project recruited nearly 10,000 women in the St. Louis area who desired contraception, gave them standardized counseling, and provided contraceptives for free.

A copper IUD. (Photo courtesy flickr/+mara/Creative Commons)

Results from the first 4,167 women to complete a year of follow-up found that 71% chose a long-acting reversible contraceptive (45% the levonorgestrel intrauterine system, 13% the copper IUD, and 13% an implant), Dr. Espey said. Others chose contraceptive pills, vaginal rings, transdermal patches, or another method.

After 12 months of use, 80% of IUD users reported being somewhat or very satisfied, compared with 54% of pill, patch, or ring users, she said. Only 55% of pill, patch, or ring users were on the same choice of contraception after 1 year compared with 84% of IUD users, 83% of implant users, and 88% of women who got a levonorgestrel intrauterine system.

The investigators recently reported that there have been 334 unintended pregnancies in 7,486 participants. Those using the pill, patch or ring were 22 times more likely to experience contraceptive failure compared with participants on long-acting reversible contraceptives (N. Engl. J. Med. 2012:366:1998-2007).

Long-acting reversible contraception was equally effective in all age groups, but use of the pill, patch, or ring was strikingly less effective in participants younger than 21 years, who were nearly twice as likely to have an unintended pregnancy compared with older women using those same methods of birth control.

–Sherry Boschert (on Twitter @sherryboschert)

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Mississippi Voters Reject Personhood Measure

The voters in Mississippi soundly rejected an attempt to change the state’s constitution to grant legal rights to embryos, starting at the time of fertilization. After intense campaigning by advocates on both sides of the abortion debate, about 58% of voters came out against the ballot measure.

The defeat of the so-called “personhood” amendment may have had less to do with traditional abortion politics, and more to do with its potential impact on the availability of birth control and fertility treatments. Dr. Douglas Laube, the board chair for Physicians for Reproductive Choice and Health, who opposed the measure, said that because the personhood amendment called for establishing rights at the time of fertilization, it would likely have meant that birth control options that prevent implantation would have been disallowed. That includes emergency contraception and intrauterine devices (IUDs), he said.

An IUD like this one might have been outlawed under the personhood amendment. Courtesy Wikimedia Commons/Gloecknerd/Creative Commons License.

In-vitro fertilization also could have been impacted. Supporters of the personhood amendment said the the availability of IVF wouldn’t have been affected, but they acknowledged that the amendment would have barred the destruction of embryos by fertility clinics since it defined a person as “every human being from the moment of fertilization, cloning, or functional equivalent thereof.”

Jennifer Mason, a spokeswoman for Personhood USA, which is promoting similar constitutional amendments around the country, said the change could end up being better for everyone. Instead of destroying excess embryos, fertility clinics could freeze them for future implantations or the embryos could be adopted by infertile couples. But the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology didn’t agree. In advance of the vote, the groups wrote to the Mississippi Secretary of State citing the uncertainty that any particular embryo will develop to become a person and calling it “unreasonable and imbalanced to give constitutional rights to fertilized eggs or embryos.”

The personhood debate is far from over. Personhood USA boasts that it is active in all 50 states and that the group plans to keep pursuing state constitutional amendments to outlaw abortion.

— Mary Ellen Schneider

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