July 29, 2003 -- Since finances matter when you're raising a family, if you think you're finished producing yours, two forms of intrauterine contraception may be your most cost-effective long-term options.
A new study, published in the July issue of the journal Contraception, suggests that the ParaGard IUD (also known as the Copper T) and the newer Mirena hormone-releasing intrauterine device are less expensive and more effective than more popular methods such as birth control pills, spermicides, and diaphragms.
Although both have upfront costs of about $500 in product and medical costs, they are the cheapest contraception types over a five-year period, when the financial price of a possible unwanted pregnancy is also calculated, says lead researcher James Trussell, PhD, a Princeton University economist and director of the school's Office of Population Research.
"Both are both extremely cost-effective options, but hardly anybody in the U.S. uses IUDs when compared to Western Europe and other parts of the world," Trussell tells WebMD. "Here, women typically choose sterilization, but elsewhere, they use IUDs instead. And unlike sterilization, these IUDs are reversible."
Types of IUDs
Mirena is a quarter-sized, plastic T-shaped device inserted into the uterus that releases a tiny amount of the hormone levonorgestrel into the uterus to prevent the passage of sperm and also prevents the uterus from forming a lining to allow implantation of a fertilized egg. It was approved by the FDA in December 2000 and came on the U.S. market in February 2001. It costs about $1,646 for its full five-year use and is nearly 99% effective.
Mirena manufacturer Berlex paid for Trussell's study.
Copper T IUDs such as ParaGard, which costs $1,678, according to Trussell, are also about 99% effective in preventing pregnancies and have been used in the U.S. for about 20 years. This new breed of IUDs -- copper-covered pieces of plastic that remain effective for up to 10 years -- also prevent pregnancy by not allowing the sperm to fertilize the egg.
The most effective form of contraception, at nearly 100%, is tubal ligation -- sterilization -- which typically costs about $2,611.
Trussell, a longtime researcher on the costs of contraception, says his study is similar to previous research suggesting that IUD devices are the best financial bet because of their high rate of preventing unwanted pregnancies, which cost about $13 billion a year in the U.S. Over a one-year period, however, IUDs are more expensive and they are not generally recommended for teenaged and young women who may later have children.
By comparison, his study -- based on having 72 sexual encounters a year -- showed the effectiveness and five-year costs of these contraceptive methods:
- Birth control pills: 96% effective, cost $2,578
- Diaphragms: 80% effective, cost $2,960
- Female condoms: 79% effective, cost $3,107
- Three-month injectable, 79% effective, costs $2,195
- Spermicides: 74% effective, cost $3,002
- Cervical caps: 60% effective, cost $3,831
These findings come as no surprise to contraception expert Mitchell D. Creinin, MD, an ob-gyn at the University of Pittsburgh School of Medicine and director of its Family Planning and Research division.
"IUDs are incredibly safe, incredibly effective, and easy to use -- and a very inexpensive procedure in the long run," he tells WebMD. "They are extremely popular in other countries, but for whatever reason, not widely used in the U.S."
One possible explanation: Only about 20% of medical insurance companies cover the costs of IUDs. "What is truly asinine is the same insurance companies that will cover sterilization, an expensive procedure that requires time in the operating room, and other forms of contraception will not cover the costs of IUDs, which provide a greater or equal efficacy as most others," Creinin says.
Another: In the U.S., IUDs continue to have bad reputation that started some three decades ago, although in most developing countries, Creinin says, they are more widely prescribed than oral contraceptives or other birth control methods. And in several European countries, they are used by at least one in four women of reproductive age.
"Back in the 1960s, the pill became the most commonly used contraception method in the U.S., but in the late '60s, studies came out suggesting it causes heart attack and strokes, so women turned to the IUD," says Creinin. "It was during the sexual revolution and there were lots of (sexually transmitted) infections, and IUDs bore the brunt of bore brunt of the blame, when in reality it was that people were sleeping around a lot."
The final nail was a series of studies in the late 1970s finding that the pill didn't cause heart attack but raised its risk in women using them who were over 35 and also smoked. "People once again became comfortable with the pill and stopped using IUDs," says Crenin. "And they have never gone back."