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Author: Laura Di Giorgio


Is contraceptive self-injection cost-effective compared to contraceptive injections from facility-based health workers? Evidence from Uganda

To assess the cost-effectiveness of self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) compared to health-worker-administered intramuscular DMPA (DMPA-IM) in Uganda. We developed a decision-tree model with a 12-month time horizon for a hypothetical cohort of approximately 1 million injectable contraceptive users in Uganda to estimate the incremental costs per pregnancy averted and per disability-adjusted life year (DALY) averted. The study design derived model inputs from DMPA-SC self-injection continuation and costing research studies and peer-reviewed literature. We calculated incremental cost-effectiveness ratios from societal and health system perspectives and conducted one-way and probabilistic sensitivity analyses to test the robustness of results.

Institutional author(s): PATH
Individual author(s): Laura Di Giorgio, Mercy Mvundura, Justine Tumusiime, Chloe Morozoff, Jane Cover, Jennifer Kidwell Drake
Publication date: August, 2018

Journal article Contraception journal

Costs of administering injectable contraceptives through health workers and self-injection: evidence from Burkina Faso, Uganda, and Senegal

To evaluate the 12-month total direct costs (medical and nonmedical) of delivering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) under three strategies – facility-based administration, community-based administration and self-injection – compared to the costs of delivering intramuscular DMPA (DMPA-IM) via facility- and community-based administration. We conducted four cross-sectional microcosting studies in three countries from December 2015 to January 2017. We estimated direct medical costs (i.e., costs to health systems) using primary data collected from 95 health facilities on the resources used for injectable contraceptive service delivery. For self-injection, we included both costs of the actual research intervention and adjusted programmatic costs reflecting a lower-cost training aid. Direct nonmedical costs (i.e., client travel and time costs) came from client interviews conducted during injectable continuation studies. All costs were estimated for one couple year of protection. One-way sensitivity analyses identified the largest cost drivers.

Institutional author(s): PATH, University of Washington
Individual author(s): Laura Di Giorgio, Mercy Mvundura, Justine Tumusiime, Allen Namagembe, Amadou Ba, Danielle Belemsaga-Yugbare, Chloe Morozoff, Elizabeth Brouwer, Marguerite Ndour, Jennifer Kidwell Drake
Publication date: May, 2018

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