The Cost of Implants

1. The Cost of Implants Cost-Effectiveness Comparisons

2. Methods Compared • Norplant • IUD • Oral Contraceptive Pill • Injection (3-month Depo Provera) • Comparisons over five years of use

3. 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

4. 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

5. 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

6. 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

7. Costs Included in Studies • Staff time • Contraceptive cost • Other supplies • Above costs influenced by service delivery practices of provider

8. 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

9. Cost Per CYP Over 5 Years Use(Kenya – 2000)

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

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

12. Cost Per CYP (Rwanda –1992)

13. Cost Per CYP Over 5 Years Use(Thailand 1994)

14. 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

15. Fee costs to the client over 5 years(Kenya – fees in shillings)

16. 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

17. 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

18. 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

19. Policy Considerations (Cont..) • Household expenditure priorities • Sustainability of method: • Staff capacity • Continuity of support • Continued availability