Abstract
Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. We assessed the cost-effectiveness of an immediate postpartum intrauterine device (PPIUD) initiative compared with standard practice in Bangladesh and Tanzania (which is no immediate postpartum family planning counseling or service provision) to inform resource allocation decisions for governments and donors. A decision analysis was constructed to compare the PPIUD program with standard practice. The analysis was based on the number of PPIUD insertions, which were then modeled using the Impact 2 tool to produce estimates of cost per couple-years of protection (CYP) and cost per disability-adjusted life years (DALYs) averted. A micro-costing approach was used to estimate the costs of conducting the program, and downstream cost savings were generated by the Impact 2 tool. Results are presented first for the program as evaluated, and second, based on a hypothetical national scale-up scenario. One-way sensitivity analyses were conducted. Compared to standard practice, the PPIUD program resulted in an incremental cost-effectiveness ratio (ICER) of US$14.60 per CYP and US$91.13 per DALY averted in Bangladesh, and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania. When incorporating estimated direct health care costs saved, the results for Bangladesh were dominant (PPIUD is cheaper and more effective versus standard practice). For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. For the national scale-up model, the results were dominant in both countries.Conclusions/implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scale-up of PPIUD could produce long-term savings in direct health care costs in both countries. These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies.
Highlights
Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings
The increasing number of women in low- and middleincome countries (LMICs) attending antenatal care and delivering in health facilities means that discussing postpartum family planning (PPFP) during antenatal care and at the time of delivery and offering effective postpartum contraception immediately postpartum are key ways to reduce the risk of unintended pregnancies.[3,5,7,12]
Our study presents an economic evaluation based on the implementation of the postpartum intrauterine device (PPIUD) initiative in Bangladesh and Tanzania, www.ghspjournal.org which was led by Federation of Gynecology and Obstetrics (FIGO) and its national member societies—the Obstetrical and Gynaecological Society of Bangladesh, the Association of Gynaecologists and Obstetricians of Tanzania, and the Tanzanian Midwifery Association
Summary
Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. Conclusions/Implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scaleup of PPIUD could produce long-term savings in direct health care costs in both countries These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies. Provision of immediate PPIUD leads to a lower risk of future unintended pregnancies and higher continued use at 6 months, versus IUD provided later This economic evaluation of the PPIUD initiative in Bangladesh and Tanzania aims to inform efforts to increase access to PPFP counseling and PPIUD provision. PPFP was often not discussed until the 6week follow-up visit, which many women do not attend and which comes after the return of fertility for women who are not exclusively breastfeeding
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
