Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal
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 a...
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doaj-6437f61dac684a1aa93a780eca9424db2020-11-25T01:12:42ZengElsevierContraception: X2590-15162019-01-011Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in SenegalMercy Mvundura0Laura Di Giorgio1Chloe Morozoff2Jane Cover3Marguerite Ndour4Jennifer Kidwell Drake5PATH, PO Box 900922, Seattle, WA 98109, USA; Corresponding author at: PO Box 900922, Seattle, WA, 98109 USA. Tel.: +1 206 302 4714.PATH, PO Box 900922, Seattle, WA 98109, USAPATH, PO Box 900922, Seattle, WA 98109, USAPATH, PO Box 900922, Seattle, WA 98109, USAPATH, BP 15115, Dakar-Fann, Dakar, SenegalPATH, PO Box 900922, Seattle, WA 98109, USAObjectives: 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 planninghttp://www.sciencedirect.com/science/article/pii/S2590151619300115 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mercy Mvundura Laura Di Giorgio Chloe Morozoff Jane Cover Marguerite Ndour Jennifer Kidwell Drake |
spellingShingle |
Mercy Mvundura Laura Di Giorgio Chloe Morozoff Jane Cover Marguerite Ndour Jennifer Kidwell Drake Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal Contraception: X |
author_facet |
Mercy Mvundura Laura Di Giorgio Chloe Morozoff Jane Cover Marguerite Ndour Jennifer Kidwell Drake |
author_sort |
Mercy Mvundura |
title |
Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal |
title_short |
Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal |
title_full |
Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal |
title_fullStr |
Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal |
title_full_unstemmed |
Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal |
title_sort |
cost-effectiveness of self-injected dmpa-sc compared with health-worker-injected dmpa-im in senegal |
publisher |
Elsevier |
series |
Contraception: X |
issn |
2590-1516 |
publishDate |
2019-01-01 |
description |
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 |
url |
http://www.sciencedirect.com/science/article/pii/S2590151619300115 |
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