Cost-Effectiveness (CEA) of Etonogestrel Subdermal Implant in a Brazilian Private Health Insurance
Author(s)
Francisco Prota, Ph.D1, Sérgio Rachkorsky, MD2, Gustavo Ribeiro Neves, MD2, Julio Cesar Prestes, MD2, Fernanda Trevisan Maldonado, MD2, Ricardo Bueno, BA, MHA, PhD3, Tiago José de Almeida Silva, MD4.
1Pontifical Catholic University of Campinas (PUCCAMP), CAMPINAS, Brazil, 2Unimed Sorocaba, Sorocaba, Brazil, 3Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil; Public Policy Program of School of Public Administration (DDPP-ENAP), São Paulo, Brazil, 4Assoc. Dir, Medical Affairs of Organon Brazil; Faculty of Medicine of Marília, Marília, São Paulo, Brazil, São Paulo, Brazil.
1Pontifical Catholic University of Campinas (PUCCAMP), CAMPINAS, Brazil, 2Unimed Sorocaba, Sorocaba, Brazil, 3Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil; Public Policy Program of School of Public Administration (DDPP-ENAP), São Paulo, Brazil, 4Assoc. Dir, Medical Affairs of Organon Brazil; Faculty of Medicine of Marília, Marília, São Paulo, Brazil, São Paulo, Brazil.
Presentation Documents
OBJECTIVES: To evaluate the cost-effectiveness of the etonogestrel implant (EI) compared to monthly and quarterly injectables, hormonal intrauterine device (IUD-h) from the perspective of the Brazilian Private Health Insurance (HMO).
METHODS: : A Markov model was developed to simulate the trajectories of 1,000 women of reproductive age over three years for each method. The model included stages of discontinuation, method switching, unintended pregnancies (including abortions, vaginal deliveries, and cesarean sections), and their associated costs. Variables such as age distribution, fertility rates, pregnancy outcomes, market share, efficacy, discontinuation, and medical costs related to contraceptive methods and pregnancies were obtained from national public databases (CMED, IBGE, PNS, TISS, SIM, and SISNAC) and published literature. Costs and benefits were discounted at 5%, and a probabilistic sensitivity analysis (PSA) was conducted to assess result robustness.
RESULTS: EI was the most effective method, preventing 47.44% to 83.33% more unplanned pregnancies compared to other methods. In terms of total costs, EI was less expensive than the IUD-h (considering outpatient and hospital costs incurred by HMO) and the monthly injectable, with a reduction of 20.45% and 16.36%, respectively, both of which were dominated due to being more expensive and less effective. In comparison to the other methods, the incremental cost-effectiveness ratio (ICER) values for EI were $1,180/QALY (quarterly injectable), well below the cost-effectiveness threshold of $6,996/QALY based on Brazil's GDP per capita. PSA confirmed the robustness of these findings, with EI demonstrating a 95% probability of being cost.
CONCLUSIONS: EI proved to be the most effective and cost-effective method among those evaluated, significantly reducing unplanned pregnancies and associated costs. Notably, indirect and social costs related to unintended pregnancies were not considered, suggesting that the economic benefits of EI may be even greater than estimated.
METHODS: : A Markov model was developed to simulate the trajectories of 1,000 women of reproductive age over three years for each method. The model included stages of discontinuation, method switching, unintended pregnancies (including abortions, vaginal deliveries, and cesarean sections), and their associated costs. Variables such as age distribution, fertility rates, pregnancy outcomes, market share, efficacy, discontinuation, and medical costs related to contraceptive methods and pregnancies were obtained from national public databases (CMED, IBGE, PNS, TISS, SIM, and SISNAC) and published literature. Costs and benefits were discounted at 5%, and a probabilistic sensitivity analysis (PSA) was conducted to assess result robustness.
RESULTS: EI was the most effective method, preventing 47.44% to 83.33% more unplanned pregnancies compared to other methods. In terms of total costs, EI was less expensive than the IUD-h (considering outpatient and hospital costs incurred by HMO) and the monthly injectable, with a reduction of 20.45% and 16.36%, respectively, both of which were dominated due to being more expensive and less effective. In comparison to the other methods, the incremental cost-effectiveness ratio (ICER) values for EI were $1,180/QALY (quarterly injectable), well below the cost-effectiveness threshold of $6,996/QALY based on Brazil's GDP per capita. PSA confirmed the robustness of these findings, with EI demonstrating a 95% probability of being cost.
CONCLUSIONS: EI proved to be the most effective and cost-effective method among those evaluated, significantly reducing unplanned pregnancies and associated costs. Notably, indirect and social costs related to unintended pregnancies were not considered, suggesting that the economic benefits of EI may be even greater than estimated.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE138
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health