The Cost of Implants Cost-Effectiveness Comparisons.

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