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Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal
- Source :
- Contraception: X, Vol 1, Iss , Pp - (2019)
- Publication Year :
- 2019
- Publisher :
- Elsevier, 2019.
-
Abstract
- Objectives: To evaluate the cost-effectiveness of self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to health-worker-administered intramuscular DMPA (DMPA-IM) in Senegal and to assess how including practice or demonstration injections in client self-injection training affects estimates. Study design: We developed a decision-tree model with a 12-month time horizon for a hypothetical cohort of 100,000 injectable contraceptive users in Senegal. We used the model to estimate incremental costs per disability-adjusted life year (DALY) averted. The analysis derived model inputs from DMPA-SC self-injection continuation and costing research studies and peer-reviewed literature. We evaluated the cost-effectiveness from societal and health system perspectives and conducted one-way and probabilistic sensitivity analyses to test the robustness of results. Results: Compared to health-worker-administered DMPA-IM, self-injected DMPA-SC could prevent 1402 additional unintended pregnancies and avert 204 maternal DALYs per year for this hypothetical cohort. From a societal perspective, self-injection costs less than health worker administration regardless of the training approach and is therefore dominant. From the health system perspective, self-injection is dominant compared to health worker administration if a one-page instruction sheet is used and one additional DMPA-SC unit is used for training and is cost-effective at $208 per DALY averted when two additional DMPA-SC units are used. Sensitivity analysis showed estimates were robust. Conclusions: Self-injected DMPA-SC averted more pregnancies and DALYs and cost less from the societal perspective compared to health-worker-administered DMPA-IM and hence is dominant. Using fewer DMPA-SC units for practice or demonstration improves cost-effectiveness of self-injection from the health system perspective. Implications: Evidence from Senegal shows that self-injection of DMPA-SC can be dominant or cost-effective from both health system and societal perspectives relative to DMPA-IM from health workers even if women practice injecting or health workers demonstrate with one or two DMPA-SC units. Evidence on whether practice or demonstration is required for client training would be useful. Keywords: Cost-effectiveness, Economic evaluation, DMPA-SC, Injectable contraception, Self-injection, Family planning
- Subjects :
- Gynecology and obstetrics
RG1-991
Public aspects of medicine
RA1-1270
Subjects
Details
- Language :
- English
- ISSN :
- 25901516
- Volume :
- 1
- Issue :
- -
- Database :
- Directory of Open Access Journals
- Journal :
- Contraception: X
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.6437f61dac684a1aa93a780eca9424db
- Document Type :
- article
- Full Text :
- https://doi.org/10.1016/j.conx.2019.100012