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I read with interest Louise Cook and Charlotte Fleming's article1 entitled ‘What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting?’ in the January 2014 issue of this Journal. It was helpful to read how a service can aim at the most efficient and cost-effective way of delivering such care. I would, however, caution any comment comparing it to that delivered in primary care. The figures quoted in the article concern the clinical and clinician costs associated with intrauterine system (IUS) fitting and follow up but do not take into account the cost of the organisation running the service or of the significant premises and administration costs of the clinic. The single fee paid via an enhanced service route to primary care for IUS fitting includes this and the ongoing clinical management but not the device and drug cost. The expenditure to the National Health Service of the two scenarios are therefore not easy to compare and this needs to be overt as those commissioning services are often removed from front line delivery and perceived cost is of great significance.
Competing interests None.
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