与乌干达年轻女性常规护理标准相比，使用计划生育福利卡提高避孕普及率的成本效益。

Cost-effectiveness of increased contraceptive coverage using family planning benefits cards compared with the standard of care for young women in Uganda.

作者信息

Nuwamanya Elly, Babigumira Joseph B, Svensson Mikael

机构信息

Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, 40530, Uganda.

GHE Consulting, P.O Box 27011, Kampala, Uganda.

出版信息

Contracept Reprod Med. 2023 Feb 13;8(1):21. doi: 10.1186/s40834-022-00206-8.

DOI:10.1186/s40834-022-00206-8

PMID:36782307

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9926799/

Abstract

BACKGROUND

Uganda has a high population growth rate of 3%, partly due to limited access to and low usage of contraception. This study assessed the cost-effectiveness of the family planning benefits cards (FPBC) program compared to standard of care (SOC). The FPBC program was initiated to increase access to modern contraception among young women in slums in Kampala, Uganda.

METHODS

We developed a decision-analytic model (decision tree) and parameterized it using primary intervention data together with previously published data. In the base case, a sexually active woman from an urban slum, aged 18 to 30 years, was modelled over a one-year time horizon from both the modified societal and provider perspectives. The main model outcomes included the probability of unintended conception, costs, and incremental cost-effectiveness ratio (ICER) in terms of cost per unwanted pregnancy averted. Both deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the modelling results. All costs were reported in 2022 US dollars, and analyses were conducted in Microsoft Excel.

RESULTS

In the base case analysis, the FPBC was superior to the SOC in outcomes. The probability of conception was lower in the FPBC than in the SOC (0.20 vs. 0.44). The average societal and provider costs were higher in the FPBC than in the SOC, i.e., $195 vs. $164 and $193 vs. $163, respectively. The ICER comparing the FPBC to the SOC was $125 per percentage reduction in the probability of unwanted conception from the societal perspective and $121 from the provider perspective. The results were robust to sensitivity analyses.

CONCLUSION

Given Uganda's GDP per capita of $1046 in 2022, the FPBC is highly cost-effective compared to the SOC in reducing unintended pregnancies among young women in low-income settings. It can even get cheaper in the long run due to the low marginal costs of deploying additional FPBCs.

TRIAL REGISTRATION

MUREC1/7 No. 10/05-17. Registered on July 19, 2017.

摘要

背景

乌干达人口增长率高达3%，部分原因是避孕措施的获取渠道有限且使用率较低。本研究评估了计划生育福利卡（FPBC）项目与标准护理（SOC）相比的成本效益。启动FPBC项目是为了增加乌干达坎帕拉贫民窟年轻女性获得现代避孕方法的机会。

方法

我们开发了一个决策分析模型（决策树），并使用主要干预数据以及先前发表的数据对其进行参数化。在基础案例中，一名来自城市贫民窟、年龄在18至30岁之间的性活跃女性，从修改后的社会和提供者角度在一年的时间范围内进行建模。主要模型结果包括意外怀孕的概率、成本以及以避免每次意外怀孕的成本计算的增量成本效益比（ICER）。进行了确定性和概率性敏感性分析，以评估建模结果的稳健性。所有成本均以2022年美元报告，分析在Microsoft Excel中进行。

结果

在基础案例分析中，FPBC在结果方面优于SOC。FPBC中的怀孕概率低于SOC（0.20对0.44）。FPBC的平均社会成本和提供者成本高于SOC，分别为195美元对164美元和193美元对163美元。从社会角度比较FPBC与SOC的ICER为每降低1%意外怀孕概率125美元，从提供者角度为121美元。结果对敏感性分析具有稳健性。