OBJECTIVES

: To estimate the cost-effectiveness (CE) of etonogestrel (ENG) implant compared to other long-term and short-term reversible contraceptive methods delivered in France

METHODS

: A 6-year CE Markov model assessed the cost and health outcomes of the implant versus other contraceptive methods (combined oral contraceptive pill [COC], progestogen-only pill, copper and hormonal intrauterine devices [IUD]) from a payer perspective. The target population was sexually active, not-pregnancy-seeking French females of reproductive age. Contraception efficacy, switch rates and outcomes following contraceptive failure (birth, extra-uterine pregnancy, miscarriage and abortion), were based on the French current medical practice data (FACET study). Costs included devices, drugs, exams and medical management (physician visits, procedures and hospitalizations). Incremental CE ratio were calculated as additional cost per pregnancy avoided. Efficiency frontier was plotted to identify cost-effective methods. Uncertainty was explored through sensitivity analyses.

RESULTS

: The ENG implant avoids 18.6‰ unplanned pregnancy per person-year (UPPY) over COC, 7.5 ‰ UPPY over copper IUD and 1.7‰ and 3.1‰ UPPY over 5 years and 3 years hormonal IUD respectively. The implant was on the efficiency frontier along with second generation (2G) COC and copper IUD. The ICER of the implant versus copper IUD was 2,221€ per pregnancy avoided (or 10,933€ per abortion avoided). Sensitivity analyses confirmed the cost-efficiency of the contraceptive implant, with an ICER varying from +8.5% to -55.7% of the base case value. At a WTPT of 10,000€ per pregnancy avoided, ENG implant had a 79.5% probability to be the most cost-effective method. For the 240,000 French women currently using the implant, the latter could prevent from 419 (versus 5y hormonal IUD) to 8,475 (versus 2G COC) unplanned pregnancies and, respectively, from 99 to 1,992 abortion per year.

CONCLUSIONS

: The ENG implant remains a cost-effective strategy compared to long-term and short-term reversible contraceptive methods.