'Implanon' Is it cost effective? An Audit of the Use of Implanon in East and North Hertfordshire.

S Uthayakumar, J Seres, F Paruk, A Agrawal, HA Davies, JA Lai

Woodlands Clinic, Stevenage, Hertdfordshire, United Kingdom

Introduction Implanon is an expensive method of contraception and has been widely used in the UK over the past 5 years. Insertion and removal are quick and there are few reported complications. The absence of oestrogen, rapid return of fertility after discontinuation, minimal required maintenance and higher efficacy rate favour Implanon over other methods, but incidence of frequent and/or irregular bleeding increases the discontinuation before the recommended 3 years.

Aims and objectives To determine if Implanon is cost effective by reviewing the continuation and discontinuation rate at 3 years, to analyse the reason for removal and to see if any improvements can be made to our service.

Results We reviewed 121 consecutive Implanon insertions from early 2001 to the autumn of 2002. This enabled us to audit each client for a minimum of 3 yrs post insertion. All received counselling prior to insertion and no complications were documented. Clients were aged from 15-44 yrs; 43 (36%) were nulliparous and 32 (26%) weighed more than 70 kg. 31 were lost to follow-up and data from the remaining 90 were analysed. 27(30%) clients had Implanon removed by year one and 44 (49%) continued over 2 years. 34 (38%) went on to have a routine removal after a minimum of 30 months and, of these, 24 (71%) had another Implanon fitted. The most common reasons for removal were irregular or frequent bleeding, weight gain and mood swings. No failure of method was reported.

Conclusion Implanon appears to be an efficacious and reasonably cost effective method of contraception for our clients. Cost effectiveness would be improved if we could reduce our discontinuation rate by spending more time on counselling prior to insertion, regarding possible side effects. We will also compare these data with our other long-term contraceptive methods such as Intra Uterine System (IUS) eg Mirena to determine the actual cost effectiveness.