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

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A Correction to this article was published on 27 October 2020

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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 < 1% of the total annual health budget of India, even if acceptance of the implant varied between 0.2 and 4%.

Conclusion

Adding the etonorgestrel implant to the public health system would be cost effective for India, with a feasible budgetary allocation.

Plain Language Summary

Many women in India do not use methods to prevent pregnancy (contraception) despite not wanting to get pregnant, due to a number of reasons. As a result, a high number of pregnancies that are either unplanned or unwanted affect the health of these women and their families and in turn the economy of the country. The government of India wishes to increase the number of contraceptive choices so that more women could prevent unwanted pregnancies. One such method under consideration is ‘Implant’. It is a match-stick sized plastic rod that contains a medicine called Etonorgestrel that acts like a female hormone. This stick is placed under the skin of the arm of the woman and can be left there for three years to prevent pregnancy.

Our study answers an important question as to whether introducing Etonorgestrel containing implant in the government’s family planning program would be good value for money and what would its impact be on the national annual health budget. To answer this question, we compiled evidence and simulated how introducing implant would affect health and costs.

Our study showed that the introduction of Etonorgestrel containing implant into the Indian public health system would be good value for money. The cost to the government would be relatively low considering the extent of improvement in health. The expenditure to roll-out this contraceptive would amount to less than 1% of the annual health budget of India even if the use of the new method would vary between 0.2 to 4%.

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Data will be made available after permission from the funding agency.

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Acknowledgements

We acknowledge the technical support of Ms Maria De Francesco, health economics consultant–Global Health and Development Group, International Decision Support Initiative (iDSI). We acknowledge the Department of Health Research, Government of India, for their technical and financial support. We acknowledge the technical support of Dr Shankar Prinja, Associate Professor of Health Economics at the Post-Graduate Institute of Medical Education and Research, Chandigarh, India. We acknowledge technical inputs from Dr Devarshi Bhattacharya, ex-staff at regional resource hub for health technology assessment. We thank Dr. S.K. Sikdhar, Deputy Commissioner Family Welfare, for his support. We acknowledge the encouragement of the Director General of the Indian Council of Medical Research and the Director of the National Institute for Research in Reproductive Health, Mumbai for their encouragement and support.

Author information

Authors and Affiliations

  1. Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India

    Beena Joshi, Kusum V. Moray & Himanshu Chaurasia

  2. Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India

    Oshima Sachin

  3. Biostatistics Department, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India

    Shahina Begum

Authors
  1. Beena Joshi
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  2. Kusum V. Moray
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  4. Himanshu Chaurasia
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  5. Shahina Begum
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Contributions

All authors contributed to the conception and design of the study. Dr Kusum Moray and Mr Himanshu Chaurasia were involved in data collection and analysis. Dr Beena Joshi, Dr Shahina Begum and Dr Oshima Sachin supervised the work. Dr Kusum Moray drafted the manuscript and all authors have reviewed the manuscript.

Corresponding author

Correspondence to Beena Joshi.

Ethics declarations

Conflicts of interest/competing interests

None.

Consent to participate

Appropriate permissions and approval from concerned authorities have been granted to collect data from healthcare facilities. No data was collected from individual patients.

Consent for publication

Not applicable (as we did not collect individual patient data for this study).

Code availability

Will be made available on request.

Ethics approval

Ethical approval has been obtained from the Indian Council of Medical Research—National Institute for Research in Reproductive Health Ethical Committee for Clinical studies (ethics approval number: D/IEC/Sci-28/30/2018).

Funding

Department of Health Research, Ministry of Health and Family Welfare, Government of India (Grant no. S.11011/08/2017-HR).

Additional information

The original version of this article was revised: “Unfortunately the Code availability statement has published incorrectly”.

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Joshi, B., Moray, K.V., Sachin, O. et al. Cost Effectiveness of Introducing Etonorgestrel Contraceptive Implant into India’s Current Family Welfare Programme. Appl Health Econ Health Policy 19, 267–277 (2021). https://doi.org/10.1007/s40258-020-00605-5

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  • DOI: https://doi.org/10.1007/s40258-020-00605-5

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