OBJECTIVES: To provide evidence of cost effectiveness and budget impact for introduction of Etonorgestrel contraceptive implant into the Indian public health system to policy makers.

METHODS : An economic evaluation and a budget impact analysis were conducted.The potential costs and effects of the current contraceptive scenario in the public health system in India was compared with a hypothetical Etonorgestrel implant scenario using a decision analytical model (Markov cohort) from a dis aggregated societal perspective. A hypothetical cohort of 15-year old females were followed till menopause, with primary outcome of Incremental Cost-Utility Ratio (ICUR). Sources for model inputs included country-level secondary data analysis, a multi-center Indian Randomized Control Trial, a primary costing study, systematic review of Etonorgestrel implant and targeted literature reviews. One-way and Probabilistic Sensitivity Analyses (OWSA and PSA) were done to account for uncertainty due to existing diversity in Indian context.

RESULTS: The base-case ICUR of USD 232.55 showed that Etonorgestrel implant was very cost effective in Indian context (ICUR was below the willingness to pay threshold of USD 2041.1) OWSA showed that percentage of people who use contraceptives, costs of managing side-effects of contraception and utility-score of Etonorgestrel implant use were the top parameters that affected ICUR. PSA showed that ICUR values of all the 1000 Monte Carlo simulations were cost-effective, making the results of the model robust. Budget impact analysis showed that introduction of the implant into the public health system of India would account for less than 0.5% of the total Indian annual health budget.

CONCLUSIONS: Adding Etonorgestrel implant to the current contraceptive basket in the public health system would be cost-effective for India, with a feasible budgetary allocation. However acceptability and feasibility studies need to be conducted before its introduction.