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 Methods Over 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 Methods Over 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)

Total Costs Over 5 Years (Kenya – 6 cycle pill re-supply)

Total Cost Over 5 Years (Kenya – 3 cycle re-supply)

Cost Per CYP (Rwanda –1992)

Cost Per CYP Over 5 Years Use (Thailand 1994)

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)

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