the cost of implants cost-effectiveness comparisons
TRANSCRIPT
The Cost of Implants
Cost-Effectiveness Comparisons
Methods Compared
Norplant IUD Oral Contraceptive Pill Injection (3-month Depo Provera) Comparisons over five years of use
Cost-Effectiveness Comparisons Provider/Client Perspectives
Alternative ways of achieving family planning goals
Cost-effectiveness analysis identifies what alternative achieves most for least cost
Budgetary constraints
What Cost Factors Are Relevant?
Initial purchase price is not adequate on its own; must also consider: Staff time costs Other supplies and equipment required
Costs to the client – these will influence demand
Contraceptive efficacy – what does the client get from the above expenditure?
Financial sustainability
Comparison of MethodsOver Five Years of Use
Compared cost per couple-year of protection
Did not consider other cost-effectiveness measures e.g cost per pregnancy avoided
Did not include the costs of potential side effects
Comparison of MethodsOver Five Years of Use
Studies cited: Kenya (Musau, S. (2000) Cost/Revenue Analysis
of Family Planning Association of Kenya clinics.) Rwanda (Nyirarukundo M. G; Hakizimana E;
Vian T. (1993) Norplant Cost Study: Rwanda Final Report. MSH/FPMD
Thailand (Janowitz, B et al. (1994) Introducing the contraceptive implant in Thailand: Impact on method use and costs. Int. Family Planning Perspectives, 20(4) Dec 1994
Costs Included in Studies
Staff time Contraceptive cost Other supplies Above costs influenced by service
delivery practices of provider
Types of visit for each method
Initial visit Check-up; Follow up/re-supply visits
IUD (Check-up 4-6 weeks after insertion then annually)
Pill – First visit – 3 cycles then 6 cycles for each re-supply visit
Norplant – Check-up 7 days after insertion then annually
Discontinuation of method - removal
Cost Per CYP Over 5 Years Use(Kenya – 2000)
0.005.00
10.0015.0020.0025.0030.0035.0040.0045.00
1 2 3 4 5
Years of contraceptive use
Do
llar
s
Norplant IUD OCP Injection
Total Costs Over 5 Years(Kenya – 6 cycle pill re-supply)
18.76
28.97
40.0144.37
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
IUD OCP Injection Norplant
US
Do
llar
s
Total Cost Over 5 Years(Kenya – 3 cycle re-supply)
18.76
36.1940.01
44.37
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
IUD OCP Injection Norplant
US
Do
llar
s
Cost Per CYP (Rwanda –1992)
-
5.00
10.00
15.00
20.00
25.00
OCP Injection - 3month
Norplant IUD Injection - 2month
US
Do
llar
s
Cost Per CYP Over 5 Years Use(Thailand 1994)
0
5
10
15
20
25
30
1 2 3 3.5 5
US
Do
llar
s
Norplant IUD Injection (3 month)
Cost-effectiveness to the User
Costs incurred vs. years of protection Some of the costs to the user are:
Fee for the service (affordability) Transport Time spent to get service (waiting time;
Number of trips) Lost opportunities for gainful employment
Fee costs to the client over 5 years(Kenya – fees in shillings)
1650
850
1150
2200
0
500
1000
1500
2000
25006 visits
6 visits
10 visits
20 visits
Conclusions From provider’s perspective IUD is the
most cost effective method Norplant has very high initial costs, but Over 5 years use cost per CYP similar
between Norplant, OCP and 3-month injectable
Important to interpret these in light of impact on client
Conclusions (cont..)
Cost effectiveness from clients perspective not adequately researched Direct costs Risks associated with chosen method
(unwanted pregnancy; STIs; infection) Impact on financial sustainability of FP
organizations
Policy Considerations re Costs
Health financing issues What method achieves highest impact for given
resource outlay? Who will pay for the contraceptives – if donors,
for how long? Are chosen methods the best investment of
available health funding? Need creative ways of financing family
planning services e.g role of community-based health financing
Policy Considerations (Cont..)
Household expenditure priorities Sustainability of method:
Staff capacity Continuity of support Continued availability