Real-world cost-effectiveness of etonogestrel implants compared to long-term and short term reversible contraceptive methods in France

Abstract

Background

To estimate the cost-effectiveness (CE) of etonogestrel implants compared to other long-term and short-term reversible contraceptive methods available in France.

Research design and methods

A 6-year Markov model compared effectiveness between the implant and six other contraceptive methods in sexually active, not-pregnancy-seeking French females of reproductive age. Contraception efficacy, switch rates and outcomes were based on French current medical practice. Incremental CE ratios (ICERs) were calculated as incremental cost per unintended pregnancy (UP) avoided. Efficiency frontier was plotted to identify cost-effective methods. Uncertainty was explored through sensitivity analyses.

Results

The implant was on the efficiency frontier along with combined oral contraceptive pill (COC) and copper IUD. Implant avoids between 0.75% and 3.53% additional UP per person-year compared to copper IUD and second generation COC, respectively, with an ICER of €2,221 per UP avoided compared to copper IUD. For the 240,000 French women currently using the implant, up to 8,475 UPs and up to 1,992 abortions may be prevented annually.

Conclusion

With more unintended pregnancies avoided and comparable costs to copper IUD, the implant is a cost-effective option among long-term and short-term reversible contraceptive methods.

摘要

背景：与法国现有的其他长期和短期可逆避孕方法相比, 评估依托孕烯埋植剂的成本效益（CE）。

研究设计和方法：一个为期6年的Markov模型, 比较了该埋植剂和其他6种避孕方法在性活跃、无怀孕需求的法国育龄女性中的有效性。避孕效果、转换率和结局基于法国当前的医疗实践。避免每意外妊娠（UP）的增量成本计算为增量成本效益比（ICER）。绘制了效率边界图, 以确定成本效益方法。通过灵敏度分析探讨了不确定度。

结果：埋植剂与口服避孕药（COC）和含铜宫内节育器（IUD）一起处于有效边界。与含铜IUD和第二代COC相比, 埋植剂可分别避免人均每年增加0.75%至3.53%的意外妊娠, 与含铜宫内节育器相比, ICER可避免2221欧元/意外妊娠。对于目前采用该埋植剂的24万法国女性来说, 每年可避免多达8475例意外妊娠和1992例流产。

结论：由于避免了更多的意外怀孕, 且成本与含铜IUD相当, 在长期和短期可逆避孕方法中, 该埋植剂是一种经济有效的选择。

Keywords:

• Contraceptive methods
• contraceptive failure
• abortion
• cost-effectiveness
• etonogestrel implant
• long-acting reversible contraceptives

Author contributions

GF and LLB were involved in the conception and design, analysis and interpretation of the data. JR and CF were involved in drafting of the paper. GF revised it critically with the help of the clinician expert TL for intellectual content. All authors gave the final approval of the version to be published; and all authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The steering committee was composed of two gynecologists Pr. Aubert Agostini and Dr. Teddy Linet.

Additional information

Funding

This study was funded by MSD France. Gaëlle FARGE and Laurie LÉVY-BACHELOT are employees of MSD. Cécile FABRON and Julien ROBERT are employees of Cemka, a contract research organisation that received funds from MSD to perform the study. Teddy LINET and Aubert AGOSTINI received consultancy fees from MSD for their contribution as clinical experts. Teddy LINET has been solicited twice, at the time of the development of the previous and current models and was also implicated into the reading of the article. Aubert AGOSTINI has been solicited for the previous model.