• 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


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


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.


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