Evidence

Surveillance report 2017 – Long-acting reversible contraception (2005) NICE guideline CG30

How we made the decision

How we made the decision

We check our guidelines regularly to ensure they remain up‑to‑date. We based the decision on surveillance 12 years after the publication of NICE's guideline on long-acting reversible contraception (NICE guideline CG30) in 2005.

For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Previous surveillance update decisions for the guideline are on our website.

Evidence

We found 55 studies in a search for randomised controlled trials and systematic reviews published between 28 August 2013 and 27 November 2016. We also included 7 relevant studies from a total of 25 studies identified by members of the guideline committee who originally worked on this guideline.

We also considered evidence (58 studies) identified in previous surveillance 8 years after publication of the guideline.

From all sources, we considered 120 studies to be relevant to the guideline.

We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.

See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline.

Views of stakeholders

The proposal to not update the guideline underwent consultation with stakeholders for 2 weeks. Overall, 12 stakeholders commented on the proposal. These were Brook Young People's Sexual Health and Wellbeing Charity; Faculty of Sexual and Reproductive Health Chalmers Centre; Medicines and Technologies Programme, NICE; Faculty of Sexual and Reproductive Healthcare (FSRH); Family Planning Association (FPA); National Society for the Mentally Handicapped (Mencap); Primary Care Women's Health Forum; University Hospitals Birmingham/Umbrella Sexual Health services; Royal College of Nursing; Advisory Group on Contraception (AGC) and 2 pharmaceutical companies. See appendix B for stakeholders' comments and NICE responses.

Three stakeholders agreed and 9 disagreed with this proposal.

Four stakeholders commented that since publication of the guideline, there have been significant changes in how contraceptive services are commissioned and provided in England, and the recommendations in the guideline no longer fit with current practice. However, these issues are addressed in other NICE guidance and products:

  • Service delivery of contraception is covered in the NICE guideline on contraceptive services for under 25s (published March 2014), with recommendations specifically directed at local authorities. The provision of sexual healthcare service covered in NICE guideline CG30 will be considered for update within NICE guideline PH51. Cross referrals between the NICE guidelines CG30 and PH51 will clarify service delivery and link NICE's products on contraceptive services.

  • NICE has also published a local government briefing on contraceptive services (LGB17, published March 2014), which specifically highlights local authority responsibilities for the provision of contraceptive services. Cross referrals between LGB17 and CG30 will address service delivery concerns and link NICE's products on contraceptive services.

  • New methods of long-acting reversible contraception (LARC) are available since development of NICE guideline CG30, including Jaydess and Levosert (intrauterine delivery systems) and Sayana Press (subcutaneous depot injection), and more information about the risks associated with these routes of administration is now available. Therefore, the guideline should be read in conjunction with the NICE evidence summaries on levonorgestrel 13.5 mg intrauterine delivery system (Jaydess) and subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (Sayana Press).

  • The NICE medicines and prescribing team will prepare a medicines prescribing briefing to provide evidence-based information for the different types of LARCs. The outdated recommendations in the guideline will be stood down and replaced with a cross referral to this medicines prescribing briefing as well as a link to the British national formulary (BNF).

  • NICE will produce a resource (icon array or options grid) that health professionals can use with patients during consultations to support shared decisions.

  • Appendix A and appendix B of the guideline will be updated to incorporate newly available products.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

NICE Surveillance programme project team

Sarah Willett (until February 2017), Kay Nolan
Associate Directors

Philip Alderson
Consultant Clinical Adviser

Katrina Sparrow (until February 2017), Judith Thornton
Technical Advisers

Maryam Gholitabar
Technical Analyst

The NICE project team would like to thank the topic experts who participated in the surveillance process.

ISBN: 978-1-4731-2495-0


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