The costs and benefits of IUD follow-up visits in the Mexican Social Security Institute

Context: In some settings, clinicians routinely schedule IUD users for foll ow-up care, but little effort has been made to compare the health benefit o f repeat visits with the costs to programs. Methods: In a prospective study at eight clinics of the Mexican Social Secu rity institute, 1,713 new IUD users were instructed to return for either tw o or four visits in the first 12 months after insertion of the device. To e stimate the health benefits and costs of each regimen, data were collected on the frequency of various medical interventions and the labor and materia l costs. Results: Of the nearly 2,000 visits made overall, 235 in the four-visit reg imen and 159 in the two-visit regimen involved medical interventions to tre at serious conditions; 53 and 29, respectively, were scheduled visits by wo men who had no symptoms but were found to require medical care. Assuming th at the program provides about 250,000 IUDs annually, costs would total $1.7 million for the four-visit and $900,000 for the two-visit regimen; the fou r-visit approach would generate 8,387 more visits involving medical interve ntions than the two-visit regimen, at a cost of $48 per visit Conclusions: Additional follow-up visits create an opportunity to diagnose and treat problems, and therefore provide increased safety for IUD users. H owever, a four-visit regimen costs much more than a two-visit approach.