OBJECTIVES

: Globally, over 200 million women are using hormonal contraceptives (HCs). Unintended pregnancies pose a major economic burden on low and middle income countries (LMIC). Budget impact analyses (BIAs) are beneficial for LMICs as they aim to make large public health investments in family planning. The objective of this study was to review cost-effectiveness analyses (CEAs) and BIAs published on HCs to assess whether future CEAs could be extended to examine national budget impact.

METHODS

: A systematic literature search was conducted using PubMed and EMBASE to identify CEAs conducted on HCs until December 2018. The selected articles were screened to assess methodological characteristics and extent of quality budget impact information. The modified BIA checklist for CEAs based on the ISPOR Task Force Recommendations was used to examine the extent to which CEAs could be used to create BIAs.

RESULTS

: A total of 22 CEAs and 2 BIAs resulted from the literature search. CEAs were conducted in 6 countries (12 USA, 6 United Kingdom and 1 each from Singapore, Iran, France and Canada). Of the 22 CEAs, 20 were conducted from a payer perspective. The 2 BIAs from USA and South Africa used a managed care and public provider perspective, respectively. Both the BIAs and CEAs examined direct medical costs with 2 CEAs each reporting direct non-medical costs and indirect costs. Actual costs of side effects were mentioned in 5 CEA’s, but not in the BIAs. The majority of the CEAs met the criteria of the BIA checklist for CEAs. The BIAs adhered well to ISPOR’s best-practice recommendations for BIA quality.

CONCLUSIONS

: This review using HCs highlights that BIAs are lacking in the literature. Current CEAs can be optimized to provide budget impact data which may be useful for LMICs as they work towards addressing resource allocation decisions to reduce the unmet need for contraception.