Independent consultant, Washington, DC, USA.
Independent consultant, Melbourne, Australia.
Glob Health Sci Pract. 2021 Mar 31;9(1):107-122. doi: 10.9745/GHSP-D-20-00447.
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. 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.
产后计划生育是改善妇女和儿童健康结果的有效手段，特别是在中低收入国家。我们评估了即时产后宫内节育器（PPIUD）计划与孟加拉国和坦桑尼亚（即没有即时产后计划生育咨询或服务提供）的标准做法相比的成本效益，为政府和捐助者的资源分配决策提供信息。
构建了决策分析来比较 PPIUD 计划与标准实践。该分析基于 PPIUD 插入的数量，然后使用 Impact 2 工具对其进行建模，以产生每对夫妇保护年数（CYP）的成本和每避免残疾调整生命年（DALY）的成本的估计。使用微观成本方法估算了开展该计划的成本，并通过 Impact 2 工具产生了下游成本节约。结果首先根据计划的评估结果呈现，其次根据假设的国家推广情景呈现。进行了单因素敏感性分析。
与标准实践相比，PPIUD 计划在孟加拉国导致每 CYP 增量成本效益比（ICER）为 14.60 美元，每 DALY 避免成本为 91.13 美元，在坦桑尼亚，每 CYP 增量成本效益比为 54.57 美元，每 DALY 避免成本为 67.67 美元。当纳入估计的直接医疗保健成本节约时，孟加拉国的结果占主导地位（PPIUD 比标准实践更便宜、更有效）。对于坦桑尼亚，PPIUD 计划具有高度成本效益，ICER（纳入直接医疗保健成本节约）估计为每 CYP 15.20 美元，每 DALY 避免成本为 18.90 美元，与标准实践相比。对于国家推广模型，两国的结果均占主导地位。PPIUD 计划在孟加拉国和坦桑尼亚都具有高度成本效益，并且在两国推广 PPIUD 可以在长期内节省直接医疗保健成本。这些分析为国家政府和国际捐助者提供了一个强有力的理由，即投资 PPIUD 作为其计划生育战略的一部分。
