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 providers 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