COST-EFFECTIVENESS AND BUDGET IMPACT OF THE ETONOGESTREL SUBDERMAL CONTRACEPTIVE IMPLANT (ESI) IN BRAZIL
Author(s)
Tassia Ginciene, MBA1, Ricardo Bueno, BA, MHA, PhD2, Yohanna Ramires, MSc3, Tiago José de Almeida Silva, MD1;
1Organon Brazil, Sao Paulo, Brazil, 2Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil, 3Organon, Fazenda Rio Grande, Brazil
1Organon Brazil, Sao Paulo, Brazil, 2Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil, 3Organon, Fazenda Rio Grande, Brazil
OBJECTIVES: To evaluate the cost-effectiveness and budget impact of the etonogestrel subdermal contraceptive implant (ESI) compared to other methods included in the Brazilian Public National List of Special Medicines (RENAME) to preventing unplanned pregnancy (UP) in in women aged 18 to 49 from a public health perspective.
METHODS: A Markov decision tree model was estimated using 3-, 5- and 10-years’ time horizons, simulating healthcare resource utilization and cost states of "pregnant" and "not pregnant." Patients could switch methods once or discontinue use, with no reinitiation allowed after discontinuation. Model parameters such as cost, age, fertility rates, pregnancy outcomes, and market share were collected from public datasets (i.e. SIGTAP, IBGE and Tabnet/DATASUS), while typical failure rates and discontinuation rates remained fixed. Fertility rates were calculated using conception rates from Trussell (85%) and adjusted for age-specific relative risks from Menken.
RESULTS: The direct cost of public healthcare with UP in Brazil was estimated at USD 745 million (R$5,5/USD). Since costs have a direct correlation to broad contraceptive method access, ESI remains the most cost-effective contraceptive compared to all other contraceptives (oral, injectables and IUD). In a 10-years horizon, the ESI was dominant compared to oral and injectable methods and presented an incremental cost-effectiveness ratio (ICER) of USD 400.53 compared to the copper IUD, which represents less than 4% of the willingness-to-pay threshold referenced in Brazil. BIA highlighted no incremental cost and reductions in UP with ESI, resulting in a cost reduction of USD 15.5 million when considering the direct cost of outcomes.
CONCLUSIONS: The findings suggest significant potential for cost reduction with ESI, supporting their expanded use to optimize contraceptive strategies, as this analysis corroborates the economic and clinical value of their expansion, providing support for health managers and policymakers.
METHODS: A Markov decision tree model was estimated using 3-, 5- and 10-years’ time horizons, simulating healthcare resource utilization and cost states of "pregnant" and "not pregnant." Patients could switch methods once or discontinue use, with no reinitiation allowed after discontinuation. Model parameters such as cost, age, fertility rates, pregnancy outcomes, and market share were collected from public datasets (i.e. SIGTAP, IBGE and Tabnet/DATASUS), while typical failure rates and discontinuation rates remained fixed. Fertility rates were calculated using conception rates from Trussell (85%) and adjusted for age-specific relative risks from Menken.
RESULTS: The direct cost of public healthcare with UP in Brazil was estimated at USD 745 million (R$5,5/USD). Since costs have a direct correlation to broad contraceptive method access, ESI remains the most cost-effective contraceptive compared to all other contraceptives (oral, injectables and IUD). In a 10-years horizon, the ESI was dominant compared to oral and injectable methods and presented an incremental cost-effectiveness ratio (ICER) of USD 400.53 compared to the copper IUD, which represents less than 4% of the willingness-to-pay threshold referenced in Brazil. BIA highlighted no incremental cost and reductions in UP with ESI, resulting in a cost reduction of USD 15.5 million when considering the direct cost of outcomes.
CONCLUSIONS: The findings suggest significant potential for cost reduction with ESI, supporting their expanded use to optimize contraceptive strategies, as this analysis corroborates the economic and clinical value of their expansion, providing support for health managers and policymakers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE174
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health