OBJECTIVES: This study aimed to evaluate the budgetary impact of the etonogestrel subdermal implant (ESI) compared to the hormonal intrauterine device (IUD) from the perspective of a private health insurance in Brazil over a 5-year time horizon.

METHODS: A budget impact analysis (BIA) was conducted using data from Unimed Sorocaba health insurance from November/2022 to October/2023. The number of eligible patients was determined considering IUD insertions in clinics (IUD-C), hospitals (IUD-H), and ESI. In each subsequent cohort, we incorporated the estimated increase in usage, calculated as the ratio between insertions and the average annual beneficiary increase. Costs were estimated based on acquisition and insertion values, considering a 5-year usage period for IUD and 3-year for ESI, in accordance with Brazilian legislation, including ESI reinsertion. The reference scenario reflected the actual distribution between IUD-C, IUD-H, and ESI, while alternative scenarios were simulated with variable ESI market shares of 10%, 20%, 30%, 40%, and 50%.

RESULTS: Over 5 years, with an annual increase, 21,346 eligible patients were identified. The cost per patient for acquisition and insertion was US$ 263.23, US$ 288.28, and US$ 662.23 for ESI, IUD-C, and IUD-H, respectively. The budget impact in the reference scenario was $8,690,467.37. Over the 5 years, ESI was associated with cost savings in the first three years, resulting in a decreasing budget impact as its market share increases: 10% -US$40,053.67, 20% -US$165,870.31, 30% -US$291,686.95, 40% -US$417,503.59, 50% -US$543,320.23.

CONCLUSIONS: The BIA highlighted a positive financial impact of adopting ESI as an alternative to the IUD. The method also exhibits potential for incorporation into social programs, as observed in Brazil, to mitigate the risk of unintended pregnancies among vulnerable populations, such as women homelessness and sex workes.