Where you live can affect your access to a form of contraception, results from my survey of Primary Care Trusts (PCT) in England has shown.
The NuvaRing, which was approved by the National Institute for Health and Clinical Excellence (NICE) for use in January 2009, could be unavailable in nearly one third of PCTs in England.
These results were obtained by a survey of PCTs in England using Freedom of Information requests. The results shown in the Google map below are preliminary, as more responses are needed for a comprehensive overview of the situation.
The NuvaRing is a form of combined hormonal contraception which comes in the form of a vaginal ring. This is left in for three weeks, and then removed for a week to allow a withdrawal bleed (similar to the pill) before another ring is inserted.
It has become clear during this investigation that the NuvaRing is still being considered for inclusion on formularies in many areas. Some PCTs can give no time frame for when a decision will be made and many do not expect a decision to be made for many months.
The reasons given for this are varied. They include a lack of information regarding where funding will come from and very frequently, a lack of demand for the product. In the case of Trafford PCT, the drug has been clinically approved but ‘financial concerns have not been resolved’.
Cost concerns arise again, even where the NuvaRing is available. Nearby Manchester’s PCT warned, ‘We advocate principles of cost effectiveness and where applicable this may mean using the drug of the lowest acquisition cost.’
The NuvaRing costs, on average, £9 a month. This figure is ‘comparatively expensive’ compared to combined contraceptive pills, which vary in cost but average a couple of pounds a month. However, it is by no means the most expensive form of contraception a couple can opt for. The new ‘morning after pill’ or ‘Plan B’, Ellaone which was launched in the UK in October 2009 costs £16.95 per dose and costs three times as much as Levonorgestrel . Implanon, one of the LARCs being recommended costs the NHS £79.46 (correct April 2009) , which is cost effective if used for 3 years, but if removed sooner than a year can prove far less cost effective than the contraceptive pill. Though of course, these figures do not take into account the cost of a pregnancy, unintended or otherwise.
All contraception is available free of charge to patients in the UK on the NHS.
Since 2005 NICE has recommended that all women requiring contraception should be offered a choice of all methods of contraception by their GP, including long-acting reversible forms of contraception (LARCs). Last year in 2009, the NHS introduced three new sexual health indicators into their Quality and Outcome Framework (QOF), which is a voluntary annual reward and incentive programme for all GP surgeries in England. These included:
- The percentage of women prescribed an oral or patch contraceptive method in the last year who have received information from the practice LARCs in the previous fifteen months and,
- The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice LARCs at the time of, or within one month of, the prescription.
Currently, the NuvaRing does not count as a LARC under NHS guidelines, but one of the benefits of use is that user error is lower; you only have to remember to change it once a month rather than take a pill every day.
In order to fulfill the NICE guidelines laid out in 2005, the NHS launched the ‘Contraception – Worth talking about’ campaign in November 2009. It was revealed in written answers to questions submitted to the Health Secretary Gillian Merron in January 2010 that estimated advertising expenditure ‘to date’ was £1,218,000 and estimated advertising costs for further activity planned for February 2010 is approximately £1,513,000. Budgets for 2010-11 and 2011-12 are currently under review.
Although some PCTs cite a lack of demand for the NuvaRing (for example in Redbridge and South Staffordshire PCTs no application had been made for the NuvaRing), South and Eastern Kent PCT reports 60 being prescribed in the last financial year.
One further problem associated with the NuvaRing is that it requires storage in a fridge. Some PCTs claim they do not have storage available for the product.
While some PCTs have banned the prescription of the NuvaRing by coding it RED or RED RED on their formularies, other PCTs have made it available to women who are unsuitable candidates for other available forms of contraception. Surrey PCT resported, in response to the FOI request submitted that, ‘The Medicine Management sub–committee (May 2009) agreed that Nuvaring® may be of benefit in a small number of patients and therefore should be available to patients in family planning clinics where other treatments are not suitable.’
I await further information to add to this investigation.
* You can become part of this investigation here.