COST-EFFECTIVENESS AND BUDGET IMPACT OF THE ETONOGESTREL SUBDERMAL IMPLANT INCORPORATING REAL-WORLD UTILIZATION DATA FROM A LARGE BRAZILIAN PRIVATE HEALTH INSURER
Author(s)
Francisco Prota, PhD1, Sérgio Rachkorsky, MD2, Fernanda Trevisan Maldonado, MD2, Julio Cesar Prestes, MD2, Tassia Ginciene, MD3, Ricardo Bueno, BA, MHA, PhD3, Yohanna Ramires, MSc3, Tiago José de Almeida Silva, MD3.
1Pontifical Catholic University of Campinas (PUCCAMP), Campinas, Brazil, 2Unimed Sorocaba, Sorocaba, Brazil., Sorocaba, Brazil, 3Organon Brazil, São Paulo, Brazil.
1Pontifical Catholic University of Campinas (PUCCAMP), Campinas, Brazil, 2Unimed Sorocaba, Sorocaba, Brazil., Sorocaba, Brazil, 3Organon Brazil, São Paulo, Brazil.
OBJECTIVES: To assess the cost-effectiveness (CEA) and budget impact (BIA) of the etonogestrel subdermal contraceptive implant compared with other reversible contraceptive methods, using real-world claim and utilization database, as an extension of a previously published economic model, in a private payer perspective.
METHODS: This Markov decision tree model implied was based on claim database data on reimbursed contraceptive utilization and substitution, insertion setting, age distribution, and historical demand observed between 2021 and 2025 from payer claim database. The target population included women aged ≥15 years. Effectiveness was measured as pregnancies avoided. Costs were expressed at R$5,5/USD. The CEA used a 3-year time horizon, while the BIA projected financial impact over 3 and 5 years. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: Total per-patient costs over 3 years were 15-25% lower than hormonal intrauterine devices and monthly injectable contraceptives, resulting in dominance or ICERs below USD 1,500 per pregnancy avoided. In the budget impact analysis, initial population target population was expanded the implant adoption to 20-30% of eligible women that generated cumulative net savings of approximately USD 0.8-1.4 million per 10,000 covered lives over 3 years, primarily driven by reductions in pregnancy-related costs and increased outpatient insertions. Results remained robust across sensitivity analyses, with outpatient insertion rates identified as a key cost driver.
CONCLUSIONS: When real-world claim database utilization data is incorporated, the etonogestrel subdermal implant is both cost-effective and budget-saving. The combined CEA and BIA demonstrate that expanding access to the implant represents a high-value strategy for private payers, supporting its prioritization within contraceptive coverage policies.
METHODS: This Markov decision tree model implied was based on claim database data on reimbursed contraceptive utilization and substitution, insertion setting, age distribution, and historical demand observed between 2021 and 2025 from payer claim database. The target population included women aged ≥15 years. Effectiveness was measured as pregnancies avoided. Costs were expressed at R$5,5/USD. The CEA used a 3-year time horizon, while the BIA projected financial impact over 3 and 5 years. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: Total per-patient costs over 3 years were 15-25% lower than hormonal intrauterine devices and monthly injectable contraceptives, resulting in dominance or ICERs below USD 1,500 per pregnancy avoided. In the budget impact analysis, initial population target population was expanded the implant adoption to 20-30% of eligible women that generated cumulative net savings of approximately USD 0.8-1.4 million per 10,000 covered lives over 3 years, primarily driven by reductions in pregnancy-related costs and increased outpatient insertions. Results remained robust across sensitivity analyses, with outpatient insertion rates identified as a key cost driver.
CONCLUSIONS: When real-world claim database utilization data is incorporated, the etonogestrel subdermal implant is both cost-effective and budget-saving. The combined CEA and BIA demonstrate that expanding access to the implant represents a high-value strategy for private payers, supporting its prioritization within contraceptive coverage policies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE172
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health