Comprehensive Evaluation For Long-Acting Contraceptive Methods

Background:With the mode of long-acting contraceptions and such a wide variety of contraceptive methods, how to evaluate them, which is an important topic to the researchers in the reproductive health field. The traditional evaluation methods focused on the clinical effect of contraceptive methods, emphasized the biological effect, especially paying attention to the efficacy and safety independently. While with various features of each contraceptions and different view and attitude of service providers and managers', the evaluation result of the contraception was different, or possibly even contradictory. And in fact the popularization and application of contraceptive methods may also influenced by the acceptability of service objects, service provision and many other factors. Therefore, based on widely clinical studies, it is necessary to integrate the viewpoints of management, providers and objects in the family planning field to evaluate contraceptive technology and products. According to the modern "biological-psychological-social medical model" and family planning service (informed choice) idea, the multidimensional and multi-objective evaluation was used. The relevant evaluation methods was explorated and applicated. It was not only consider efficacy, safety, also introduced biological effects indexes of psychology, economics, satisfaction and acceptability, etc.Objective:With the initially established comprehensive evaluation index system of contraceptive methods, the Delphi method was used to adjust and radicate the comprehensive evaluation index system for long-acting contraceptive methods. The comprehensive statistic methods of TOPSIS, osculating value, efficacy coefficient, weighted composite Index and RSR were used respectively to evaluate intrauterine devices (IUD) including Yuan Gong Copper 300, TCu380A and activity 165, female tubal sterilization including the modified Uchida technique and the application of silver clips) and vasectomy. Finally, the adaptive statistic methods of comprehensive evaluation for long-acting contraception are identified with Spearman rank correlation coefficient, Borda method and Clustering analysis.Methods: Based on the previous work, according to the principles of Delphi method, we consulted family planning, epidemiological, gynecological and obstetrical experts who were anthoritative in their respective fields. AfterTwo rounds of consulting were proceeded, we concluded the feedback opinions and calculated relevant parameters. Finaly, the comprehensive evaluation index system of long-acting contraceptive methods was adjusted and radicated. Specialist-score method and Satty's score weighting method were adopted to determine the weight of each index.Data resource:Based on the previous research findings, this study used indexes value of effectiveness, side effects and acceptability obtained from the questionnaires of healthy life quality (SF-36) and prospective clinical trials of three types of IUD placement during intermenstruum (Yuan Gong Copper 300,TCu380A and activity 165), two female tubal sterilization methods (the modified Uchida technique and the application of silver clips) and vasectomy. Cost-effect value in the evaluation system of the long-acting comprehensive methods was obtained from the health economics research of those family planning services agencies. The prospective clinical trials and health economics research were supported by the National Key Technology Program of "Eleventh Five-Year".With above data, TOPSIS, osculating value, efficacy coefficient, weighted Composite Index and RSR were used respectively to evaluate the 6 above contraceptive methods, Borda method was used to evaluate the results of adaptive statistic methods and the 6 contraceptions were classified with Clustering analysis. Compared with Borda method, Spearman rank correlation coefficient was used to identify the consistency of the results of 5 statistic methods. EpiData3.0, Excel 2003, SPSS13.0, WHO LTA2.0 and SAS 9.1 statistical software were used for data management and analysis.Results:1. The structure of evaluation system of the long-acting comprehensive methods was lied in the following table: 2. The values and orders of TOPSIS, osculating value, efficacy coefficient, weighted Composite Index and RSR for 3 types of IUD and 3 kinds of sterilization were lied in the following table.3. Borda method was used to organize the above 5 results of TOPSIS, osculating value, efficacy coefficient, weighted Composite Index and RSR methods. The Board values and orders for 3 types of IUD and 3 kinds of sterilization were 192.44 for the modified Uchida technique ranking first; 68.60 for vasectomy ranking second,16.11 for Yuan Gong Copper 300 IUD ranking third,15.15 for silver clips ranking the fourth, 14.38 for activity 165 IUD ranking fifth, and 5.16 for TCu380A IUD ranking sixth.4. Clustering analysis was used to classify the 3 types of IUD and 3 kinds of sterilization into three categories. The first category included the modified Uchida technique and vasectomy. The second category included silver clips and Yuan Gong Copper 300 IUD. The third category included TCu380A IUD and activity 165 IUD.5. Spearman correlation coefficient method was used to analysis the results of TOPSIS, osculating value, efficacy coefficient, weighted Composite Index, RSR and Borda method. The Spearman correlation coefficient between TOPSIS and Borda method was 0.9856 (>rs=0.886). The results of TOPSIS was conformed with that of Borda method.Conclusion:1. With 3 first-level indicators,6 second-level indicators,13 third-level indicators and weighty for each indicators, the comprehensive evaluation system for long-acting comprehensive methods was established.2. The results of TOPSIS was conformed with that of Borda method. TOPSIS method was identified as the most suitable comprehensive evaluation methods for long-acting contraception.3. The result of Borda method and Clustering analysis was conformed with each other. Comprehensive effects of the modified Uchida technique and vasectomy were the best, then the Yuan Gong Copper 300 IUD and silver clips, TCu380A and activity 165 IUD were the last.Suggestion:With consideration of many factors on many aspects, the comprehensive evaluation method is a significative system for contraceptions. It shoule be suggested to bring into clinic study and epidemiology as a part of statistic analysis.