Bergen Centre for Ethics and Priority Setting, Institute of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5009, Bergen, Norway.
Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States.
Soc Sci Med. 2021 Jul;281:114076. doi: 10.1016/j.socscimed.2021.114076. Epub 2021 May 25.
Despite recent advances in access to and use of modern contraception in Ethiopia, further improvement is needed, particularly among poorer women. This extended cost-effectiveness analysis investigated the health outcomes, their distribution, and financial risk protection associated with meeting the demand for modern contraception for all Ethiopian women. We developed five Markov models with wealth quintile-specific input data to investigate the effects of meeting this demand and followed a hypothetical cohort of 1,252,000 women through their reproductive lives from ages 15-49 years. The health outcomes are reported in quality-adjusted life years (QALYs) gained and in intermediate health outcomes, such as the total number of induced abortions, unintended pregnancies, and pregnancy-related deaths averted. The economic effect of meeting the demand for modern contraception was assessed by estimating the financial risk protection benefits in terms of averted out-of-pocket payments and the reduction in the number of cases of catastrophic health expenditure by quintile. Meeting the demand for modern contraception was deemed highly cost effective, with an incremental cost-effectiveness ratio of $96.60/QALY gained per woman. A total of 676,300 QALYs were gained, and approximately 1,900,000 unintended pregnancies, 250,000 induced abortions, and 9000 pregnancy-related deaths were averted over the 35-year period. Most of these gains were achieved among low-income groups. When the demand for modern contraception was met, almost 40,000 cases of catastrophic health expenditure were averted in the poorest quintile. The total governmental cost was higher in all quintiles when the demand for modern contraception was met compared to the baseline scenario, with the largest percentage increase in governmental spending in the poorest quintiles. Meeting the demand for modern contraception fulfills the priority-setting criteria established by the Ethiopian Ministry of Health and makes the Ethiopian health care system more equitable.
尽管埃塞俄比亚在获取和使用现代避孕措施方面取得了进展,但仍需要进一步改善,特别是在贫困妇女中。这项扩展的成本效益分析研究了满足所有埃塞俄比亚妇女对现代避孕措施的需求所带来的健康结果、其分布情况和财务风险保护。我们开发了五个马尔可夫模型,使用财富五分位数特定的输入数据来研究满足这一需求的效果,并对一个 1252000 名女性的假想队列进行了跟踪,这些女性的年龄在 15 至 49 岁之间。健康结果以获得的质量调整生命年(QALY)和中间健康结果报告,例如总人工流产、意外妊娠和避免的妊娠相关死亡数量。通过估计避免自付费用和按五分位数减少灾难性卫生支出的数量来评估满足现代避孕需求的经济效果。满足现代避孕需求被认为具有高度成本效益,每个妇女的增量成本效益比为 96.60 美元/QALY。在 35 年内,总共获得了 676300 个 QALY,并避免了约 190 万例意外妊娠、25 万例人工流产和 9000 例妊娠相关死亡。这些收益大多是在低收入群体中实现的。当满足现代避孕需求时,最贫困的五分位数避免了近 40000 例灾难性卫生支出。与基线情景相比,在所有五分位数中,当满足现代避孕需求时,政府总支出都更高,最贫困五分位数的政府支出增长百分比最大。满足现代避孕需求符合埃塞俄比亚卫生部确定的优先事项设定标准,使埃塞俄比亚的医疗保健系统更加公平。