COST-EFFECTIVENESS OF THE DIFFERENT CONTRACEPTIVE SERVICE PROVISIONS IN THE MINISTRY OF HEALTH FACILITIES IN MALAYSIA

Authors

  • Zafar Ahmed 2Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak 94300 Kota Samarahan, Sarawak, Malaysia
  • Mohamad Hafiz Harun Tumpat District Health Office, Ministry of Health Malaysia, 16200 Tumpat, Kelantan, Malaysia

Keywords:

cost-effectiveness analysis, Markov model, contraception, primary care, Malaysia, cost-effectiveness analysis Markov model, contraception, primary care, Malaysia, cost-effectiveness analysis, Markov model,

Abstract

The aim of this study was to evaluate the cost-effectiveness of the various contraceptive methods, from the perspective
of health providers (Ministry of Health). An economic evaluation compared the costs and outcomes of the intra-uterine
contraceptive device (IUCD), depot medroxy-progesterone acetate (DMPA) injectable, oral contraceptive pill (OCP) and
contraceptive implant provisions in the government-funded health clinics. Data from the various government entities
in Malaysia particularly Ministry of Health were used to estimate costs. The probabilities of contraceptive failure were
sourced from literature. Using a 5-year Markov model, our results were estimated and subjected to sensitivity analyses.
The model included 83,500 sexually active women. Model output was expressed as the cost per pregnancy averted.
Over 5 years, OCP and DMPA injectable are both “dominated” when compared with IUCD method. Whereas, IUCD and
implant fall under the “undominated” category. The results suggest the implant to be the most cost-effective option
for women of reproductive age, with ICER of MYR6,736.57 per pregnancy averted when compared to IUCD. The results
were sensitive to costs of implant, costs of IUCD and effectiveness of IUCD. From health providers’ perspective, if
providing various contraceptive services justly, and assuming an implicit willingness to accept threshold of MYR50,000
the implant is the most cost-effective. The implant provision could provide substantial long-term benefits in reducing
unintended pregnancies and healthcare costs. This could be useful information for policymakers considering a largescale implant provision for Malaysian women in the government health facilities to prevent unintended pregnancies.

References

United Nations. Contraceptive Use by Method 2019. Data Booklet (ST/ESA/SER.A/435). New York: Department of Economic and Social Affairs Population Division;2019.

LPPKN, UNFPA. Situational Analysis on Family Planning and Reproductive Health Education in Malaysia and Other Selected Muslim Countries. In: National Population and Family Development Board (LPPKN) of the Ministry of Women Family and Community Development Malaysia and United Nations Population Fund (UNFPA) Malaysia, ed. Kuala Lumpur: Human Reproduction Division of LPPKN; 2020.

Yusof M, Samad AA, Omar M, Ahmad NA. Unplanned Pregnancy and Its Associated Factors. Global Journal of Health Science. 2018;10(8).

Sonnenberg FA, Burkman RT, Hagerty CG, Speroff L, Speroff T. Costs and net health effects of contraceptive methods. Contraception. 2004;69(6):447-459.

Trussell J, Leveque JA, Koenig JD, et al. The economic value of contraception: a comparison of 15 methods. Am J Public Health. 1995;85(4):494-503.

LPPKN. Report on Key Findings Fifth Malaysian Population and Family Survey [MPFS-5] 2014. Population and Family Research Sector, National Population and Family Development Board (NPFDB) Malaysia, Kuala Lumpur: Population and Family Research Sector, National Population and Family Development Board (NPFDB) Malaysia, Kuala Lumpur;2016.

Tey NP. The global family planning revolution: three decades of population policies and programs. Washington, DC: World Bank Publications; 2007.

AGC. Population and Family Development Act 1966 (Act 352) Revised 1988. In. Putrajaya: Attorney General's Chambers of Malaysia.; 1966.

Najimudeen M, Sachchithanantham K. An insight into low contraceptive prevalence in Malaysia and its probable consequences. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):493-496.

United Nations. Trends in Contraceptive Use Worldwide. The Department of Economic and Social Affairs, Population Division, New York: United Nations;2015.

New Straits Times. Khairy: White Paper to put Malaysian health system on sustainable footing. New Straits Times Press (M) Bhd2022.

Henry N, Hawes C, Lowin J, Lekander I, Filonenko A, Kallner HK. Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden. Acta Obstet Gynecol Scand. 2015;94(8):884-890.

Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J. Cost effectiveness of contraceptives in the United States. Contraception. 2009;79(1):5-14.

Mavranezouli I. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Human Reproduction. 2008;23(6):1338-1345.

Lipetz C, Phillips CJ, Fleming CF. The cost-effectiveness of a long-acting reversible contraceptive (Implanon) relative to oral contraception in a community setting. Contraception. 2009;79(4):304-309.

Rodriguez MI, Caughey AB, Edelman A, Darney PD, Foster DG. Cost-benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States. Contraception. 2010;81(4):304-308.

Department of Statistics Malaysia. eStatistik Publication, Statistics Yearbook Malaysia (population). DOSM. https://newss.statistics.gov.my/newss-portalx/ep/epFreeDownloadContentSearch.seam?cid=111529. Published 2018. Accessed October 1, 2020.

JPA. Indeks Jadual Gaji Minimum-Maksimum Perkhidmatan Awam Malaysia. In: Civil Service Department PMsO, ed. Putrajaya: Civil Service Department, Prime Minister's Office.; 2016.

Harun MH, Ahmed Z. Costs Estimation in Providing Contraceptive Methods in Klinik Kesihatan in Malaysia. International Journal of Public Health and Clinical Sciences. 2023;10(1):1-13.

Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404.

Edwards JE, Moore A. Implanon. A review of clinical studies. The British journal of family planning. 1999;24(4 Suppl):3-16.

Croxatto HB, Urbancsek J, Massai R, Bennink HC, van Beek A. A multicentre efficacy and safety study of the single contraceptive implant Implanon®. Human Reproduction. 1999;14(4):976-981.

Jayatunga W. Contraception: Economic analysis estimation of the return on investment (ROI) for publicly funded contraception in England. United Kingdom: Public Health England;2018.

MOH. Pharmacoeconomic Guidelines for Malaysia (Second Edition) 2019. In: Pharmacy Practice & Development Division PSP, ed. Vol Second Edition. Petaling Jaya, Selangor: Ministry of Health Malaysia; 2019:19.

World Bank. World Databank - Country Malaysia. The World Bank Group. The World Bank Group. https://data.worldbank.org/country/MY. Published 2021. Accessed January 2, 2022.

Sweileh WM, Barham AM. Contraceptive Methods: Cost/Effectiveness Ratio from a Customer’s Perspective in Palestine. An-Najah University Journal for Research. 2003;17(1):43-51.

Lafuma A, Agostini A, Linet T, Robert J, Levy-Bachelot L, Godard C. Cost-effectiveness of Nexplanon®(Etonogestrel Implant) compared to other reimbursed contraceptive methods in France based on real life Data. Value in Health. 2015;18(7):A735-A736.

Harrison D, Saur KA. Estimating the Relative Cost Effectiveness of Four Contraceptive Methods in the Prevention of Unwanted Pregnancies within Departmènt of Defense Active-Duty Women. Journal of Managed Care Pharmacy. 1999;5(2):131-136.

Nakhaee N, Mirahmadizadeh AR, Gorji HA, Mohammadi M. Assessing the cost-effectiveness of contraceptive methods in Shiraz, Islamic Republic of Iran. East Mediterr Health J. 2002;8(1):55-63.

USAID. The Cost of Family Planning in Kenya. Washington, DC: Health Policy Initiative, Task Order 1, Futures Group, U.S. Agency for International Development: Health Policy Initiative, Task Order 1, Futures Group, The USAID;2010.

United States Agency for International Development (USAID). The Cost of Family Planning in Kenya. Health Policy Initiative, Task Order 1, Futures Group, The USAID. http://www.healthpolicyplus.com/archive/ns/pubs/hpi/Documents/1189_1_1189_1_Kenya_Brief_FINAL_7_12_10_acc.pdf. Published 2010. Updated October 2, 2021. Accessed.

Lynch M, De Abreu Lourenco R, Flattery M, Haas M. Reviewing the cost-effectiveness of long-acting reversible contraceptive methods in an Australian context. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2019;59(1):21-35.

National Population and Family Development Board. Report on Key Findings Fifth Malaysian Population and Family Survey [MPFS-5] 2014. Population and Family Research Sector, National Population and Family Development Board (NPFDB) Malaysia,. http://familyrepository.lppkn.gov.my/659/1/Report%20on%20Key%20Findings%20%20Fifth%20Malaysian%20Populationand%20Family%20Survey%20%28MPFS-5%29%202014.pdf. Published 2016. Accessed June 1, 2020.

Phillips CJ. Economic Analysis of Long Term Reversible Contraceptives - focus on implanon(R). PharmacoEconomics. 2000;17(2):209-221.

Varney SJ, Guest JF. Relative cost effectiveness of Depo-Provera, Implanon, and Mirena in reversible long-term hormonal contraception in the UK. Pharmacoeconomics. 2004;22(17):1141-1151.

Victora CG, Hanson K, Bryce J, Vaughan JP. Achieving universal coverage with health interventions. Lancet. 2004;364(9444):1541-1548.

Concepcion K, Lacey S, McGeechan K, Estoesta J, Bateson D, Botfield J. Cost-benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia. Aust Health Rev. 2019.

Suwantika AA, Zakiyah N, Puspitasari IM, Abdulah R. Cost-Effectiveness of Contraceptive Use in Indonesia after the Implementation of the National Health Insurance System. Journal of Pregnancy. 2021.

Williams P, Morales K, Sridharan V, Tummala A, Marseille E. Postpartum family planning in Rwanda: a cost effectiveness analysis. Gates Open Research. 2019;3:887.

Lewandowska M, Lourenco RDA, Haas M, et al. Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia. Australian Health Review. 2021;45(6):728-734.

Downloads

Published

2023-12-28

How to Cite

Ahmed, Z., & Harun, M. H. (2023). COST-EFFECTIVENESS OF THE DIFFERENT CONTRACEPTIVE SERVICE PROVISIONS IN THE MINISTRY OF HEALTH FACILITIES IN MALAYSIA. Malaysian Journal of Public Health Medicine, 23(3), 1–12. Retrieved from http://mjphm.org/index.php/mjphm/article/view/1806