OBJECTIVES: To reassess the cost-effectiveness of etonogestrel implant compared to other contraceptive methods delivered in France.

METHODS: The 6-year cost-effectiveness societal perspective model from 2020 has been updated to assess the cost and health outcomes of the implant versus other contraceptive methods (combined oral contraceptive pill (COC), progestogen-only pill, copper and hormonal intrauterine device (IUD)) among sexually active, not-pregnancy-seeking French females of reproductive age. Economic parameters such as treatment costs or gynecological follow-up costs were updated with the most recent databases. Other parameters such as contraception efficacy, switch rates and outcomes following contraceptive failure, coming from French medical practice data (FACET study), have not been modified.

RESULTS: The implant is still the most effective contraceptive method with 1.7‰ unplanned pregnancy (UP) avoided per person-year (PPY) over 5 years hormonal IUD (35.3‰ UP avoided PPY over second generation (2G) COC). At its current price, incremental costs of the implant range from €-28.4 (savings) over third or fourth generation (3/4G) COC to €+45.4 (extra-costs) over 2G COC respectively. The implant remains on the efficiency frontier with 2G COC and copper IUD and dominates hormonal IUDs. The ICER of the implant versus copper IUD is €2,245 per pregnancy avoided (+1.1% compared to the previous analysis). Sensitivity analyses, including variation of efficacy data or contraceptive persistence rate had a moderate impact on ICER varying from -44.6% to +34.4% of the base case value. Two new scenarios confirmed the efficiency of the implant: the inclusion of midwives in gynecological follow-up and the extension of the efficacy duration of the implant from 3 to 5 years, with a decrease in the ICER of 13% and 42% respectively.

CONCLUSIONS: The efficiency of the implant compared to long-term and short-term reversible contraceptive methods is not challenged and is even destined to continue in case its duration is increased.