Cost Effectiveness of Introducing Etonorgestrel Contraceptive Implant into India’s Current Family Welfare Programme

Beena Joshi (), Kusum V. Moray, Oshima Sachin, Himanshu Chaurasia and Shahina Begum
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Beena Joshi: National Institute for Research in Reproductive Health
Kusum V. Moray: National Institute for Research in Reproductive Health
Oshima Sachin: Ministry of Health and Family Welfare
Himanshu Chaurasia: National Institute for Research in Reproductive Health
Shahina Begum: National Institute for Research in Reproductive Health

Applied Health Economics and Health Policy, 2021, vol. 19, issue 2, No 12, 267-277

Abstract: Abstract Objectives The aim of this study was to provide evidence to policy makers on cost effectiveness and budget impact for the introduction of the etonorgestrel implant into the Indian public health system. Methods An economic evaluation was conducted to ascertain the potential costs and outcomes of adding the etonorgestrel implant to the public health system of India as compared to the current scenario. A decision analytical model (Markov cohort) was conceptualized from a societal perspective, where a hypothetical population of 15-year-old females was followed until menopause. The primary outcome was incremental cost-utility ratio (ICUR). Sources for model inputs included country-level secondary data analysis, government reports, an observational primary costing study, a systematic review of etonorgestrel implant and targeted literature reviews. One-way and probabilistic sensitivity analyses (OWSA and PSA) were performed to account for uncertainty. The impact of etonorgestrel implant introduction on the annual Indian health budget was also analysed. Results The base-case ICUR was 16,475 Indian rupees (INR) (USD 232) per quality-adjusted life-year gained, which showed the etonorgestrel implant to be very cost effective (ICUR below willingness-to-pay threshold of INR 137,945 [USD 1943]). OWSA showed that discount rate, percentage of people who do not use contraceptives and costs of managing side effects were the important parameters that affected ICUR. PSA showed that ICUR values of all 1000 Monte Carlo simulations were cost effective. Budget impact analysis showed that introduction of the implant would account for

Date: 2021
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DOI: 10.1007/s40258-020-00605-5

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