Cost-Effectiveness of Introducing the SILCS Diaphragm in South Africa
Identifieur interne : 000E37 ( Pmc/Checkpoint ); précédent : 000E36; suivant : 000E38Cost-Effectiveness of Introducing the SILCS Diaphragm in South Africa
Auteurs : Aurélia Lépine [Royaume-Uni] ; Neeti Nundy [États-Unis] ; Maggie Kilbourne-Brook [États-Unis] ; Mariana Siapka [Royaume-Uni] ; Fern Terris-Prestholt [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Though South Africa has high contraceptive use, unintended pregnancies are still widespread. The SILCS diaphragm could reduce the number of women with unmet need by introducing a discreet, woman-initiated, non-hormonal barrier method to the contraceptive method mix.
A decision model was built to estimate the impact and cost-effectiveness of the introduction of the SILCS diaphragm in Gauteng among women with unmet need for contraception in terms of unintended and mistimed pregnancies averted, assuming that the available contraceptives on the market were not a satisfying option for those women. Full costs were estimated both from a provider’s and user’s perspective, which also accounts for women’s travel and opportunity cost of time, assuming a 5% uptake among women with unmet contraceptive need. The incremental cost-effectiveness ratio is computed at five and 10 years after introduction to allow for a distribution of fixed costs over time. A probabilistic sensitivity analysis was conducted to incorporate decision uncertainty.
The introduction of the SILCS diaphragm in Gauteng could prevent an estimated 8,365 unintended pregnancies and 2,117 abortions over five years, at an annual estimated cost of US$55 per woman. This comes to a cost per pregnancy averted of US$153 and US$171 from a user’s and provider’s perspectives, respectively, with slightly lower unit costs at 10 years. Major cost drivers will be the price of the SILCS diaphragm and the contraceptive gel, given their large contribution to total costs (around 60%).
The introduction of the SILCS diaphragm in the public sector is likely to provide protection for some women for whom current contraceptive technologies are not an option. However to realize its potential, targeting will be needed to reach women with unmet need and those with likely high adherence. Further analyses are needed among potential users to optimize the introduction strategy.
Url:
DOI: 10.1371/journal.pone.0134510
PubMed: 26295955
PubMed Central: 4546642
Affiliations:
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PMC:4546642Le document en format XML
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Though South Africa has high contraceptive use, unintended pregnancies are still widespread. The SILCS diaphragm could reduce the number of women with unmet need by introducing a discreet, woman-initiated, non-hormonal barrier method to the contraceptive method mix.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>A decision model was built to estimate the impact and cost-effectiveness of the introduction of the SILCS diaphragm in Gauteng among women with unmet need for contraception in terms of unintended and mistimed pregnancies averted, assuming that the available contraceptives on the market were not a satisfying option for those women. Full costs were estimated both from a provider’s and user’s perspective, which also accounts for women’s travel and opportunity cost of time, assuming a 5% uptake among women with unmet contraceptive need. The incremental cost-effectiveness ratio is computed at five and 10 years after introduction to allow for a distribution of fixed costs over time. A probabilistic sensitivity analysis was conducted to incorporate decision uncertainty.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The introduction of the SILCS diaphragm in Gauteng could prevent an estimated 8,365 unintended pregnancies and 2,117 abortions over five years, at an annual estimated cost of US$55 per woman. This comes to a cost per pregnancy averted of US$153 and US$171 from a user’s and provider’s perspectives, respectively, with slightly lower unit costs at 10 years. Major cost drivers will be the price of the SILCS diaphragm and the contraceptive gel, given their large contribution to total costs (around 60%).</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>The introduction of the SILCS diaphragm in the public sector is likely to provide protection for some women for whom current contraceptive technologies are not an option. However to realize its potential, targeting will be needed to reach women with unmet need and those with likely high adherence. Further analyses are needed among potential users to optimize the introduction strategy.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Williamson, Lm" uniqKey="Williamson L">LM Williamson</name>
</author>
<author><name sortKey="Parkes, A" uniqKey="Parkes A">A Parkes</name>
</author>
<author><name sortKey="Wight, D" uniqKey="Wight D">D Wight</name>
</author>
<author><name sortKey="Petticrew, M" uniqKey="Petticrew M">M Petticrew</name>
</author>
<author><name sortKey="Hart, Gj" uniqKey="Hart G">GJ Hart</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Sonfield, A" uniqKey="Sonfield A">A Sonfield</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Schwartz, Jl" uniqKey="Schwartz J">JL Schwartz</name>
</author>
<author><name sortKey="Ballagh, Sa" uniqKey="Ballagh S">SA Ballagh</name>
</author>
<author><name sortKey="Creinin, Md" uniqKey="Creinin M">MD Creinin</name>
</author>
<author><name sortKey="Rountree, Rw" uniqKey="Rountree R">RW Rountree</name>
</author>
<author><name sortKey="Kilbourne Brook, M" uniqKey="Kilbourne Brook M">M Kilbourne-Brook</name>
</author>
<author><name sortKey="Mauck, Ck" uniqKey="Mauck C">CK Mauck</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Trussell, J" uniqKey="Trussell J">J Trussell</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Trussell, J" uniqKey="Trussell J">J Trussell</name>
</author>
<author><name sortKey="Lalla, Am" uniqKey="Lalla A">AM Lalla</name>
</author>
<author><name sortKey="Doan, Qv" uniqKey="Doan Q">QV Doan</name>
</author>
<author><name sortKey="Reyes, E" uniqKey="Reyes E">E Reyes</name>
</author>
<author><name sortKey="Pinto, L" uniqKey="Pinto L">L Pinto</name>
</author>
<author><name sortKey="Gricar, J" uniqKey="Gricar J">J Gricar</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Foss, A" uniqKey="Foss A">A Foss</name>
</author>
<author><name sortKey="Terris Prestholt, F" uniqKey="Terris Prestholt F">F Terris Prestholt</name>
</author>
<author><name sortKey="Cox, A" uniqKey="Cox A">A Cox</name>
</author>
<author><name sortKey="Heise, L" uniqKey="Heise L">L Heise</name>
</author>
<author><name sortKey="Meyer Rath, G" uniqKey="Meyer Rath G">G Meyer-Rath</name>
</author>
<author><name sortKey="Delany Moretlwe, S" uniqKey="Delany Moretlwe S">S Delany-Moretlwe</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Terris Prestholt, F" uniqKey="Terris Prestholt F">F Terris-Prestholt</name>
</author>
<author><name sortKey="Kumaranayake, L" uniqKey="Kumaranayake L">L Kumaranayake</name>
</author>
<author><name sortKey="Obasi, Ain" uniqKey="Obasi A">AIN Obasi</name>
</author>
<author><name sortKey="Cleophas Mazige, B" uniqKey="Cleophas Mazige B">B Cleophas-Mazige</name>
</author>
<author><name sortKey="Makokha, M" uniqKey="Makokha M">M Makokha</name>
</author>
<author><name sortKey="Todd, J" uniqKey="Todd J">J Todd</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Meyer Rath, G" uniqKey="Meyer Rath G">G Meyer-Rath</name>
</author>
<author><name sortKey="Miners, A" uniqKey="Miners A">A Miners</name>
</author>
<author><name sortKey="Santos, Ac" uniqKey="Santos A">AC Santos</name>
</author>
<author><name sortKey="Variava, E" uniqKey="Variava E">E Variava</name>
</author>
<author><name sortKey="Venter, Wdf" uniqKey="Venter W">WDF Venter</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Eaton, Jw" uniqKey="Eaton J">JW Eaton</name>
</author>
<author><name sortKey="Menzies, Na" uniqKey="Menzies N">NA Menzies</name>
</author>
<author><name sortKey="Stover, J" uniqKey="Stover J">J Stover</name>
</author>
<author><name sortKey="Cambiano, V" uniqKey="Cambiano V">V Cambiano</name>
</author>
<author><name sortKey="Chindelevitch, L" uniqKey="Chindelevitch L">L Chindelevitch</name>
</author>
<author><name sortKey="Cori, A" uniqKey="Cori A">A Cori</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Skoler Karpoff, S" uniqKey="Skoler Karpoff S">S Skoler-Karpoff</name>
</author>
<author><name sortKey="Ramjee, G" uniqKey="Ramjee G">G Ramjee</name>
</author>
<author><name sortKey="Ahmed, K" uniqKey="Ahmed K">K Ahmed</name>
</author>
<author><name sortKey="Altini, L" uniqKey="Altini L">L Altini</name>
</author>
<author><name sortKey="Plagianos, Mg" uniqKey="Plagianos M">MG Plagianos</name>
</author>
<author><name sortKey="Friedland, B" uniqKey="Friedland B">B Friedland</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rosen, S" uniqKey="Rosen S">S Rosen</name>
</author>
<author><name sortKey="Ketlhapile, M" uniqKey="Ketlhapile M">M Ketlhapile</name>
</author>
<author><name sortKey="Sanne, I" uniqKey="Sanne I">I Sanne</name>
</author>
<author><name sortKey="Desilva, Mb" uniqKey="Desilva M">MB DeSilva</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Piper, A" uniqKey="Piper A">A Piper</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Owusu Edusei, K" uniqKey="Owusu Edusei K">K Owusu-Edusei</name>
</author>
<author><name sortKey="Gift, Tl" uniqKey="Gift T">TL Gift</name>
</author>
<author><name sortKey="Ballard, Rc" uniqKey="Ballard R">RC Ballard</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Rydzak, Ce" uniqKey="Rydzak C">CE Rydzak</name>
</author>
<author><name sortKey="Goldie, Sj" uniqKey="Goldie S">SJ Goldie</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Trussell, J" uniqKey="Trussell J">J Trussell</name>
</author>
<author><name sortKey="Leveque, Ja" uniqKey="Leveque J">JA Leveque</name>
</author>
<author><name sortKey="Koenig, Jd" uniqKey="Koenig J">JD Koenig</name>
</author>
<author><name sortKey="London, R" uniqKey="London R">R London</name>
</author>
<author><name sortKey="Borden, S" uniqKey="Borden S">S Borden</name>
</author>
<author><name sortKey="Henneberry, J" uniqKey="Henneberry J">J Henneberry</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Moench, Tr" uniqKey="Moench T">TR Moench</name>
</author>
<author><name sortKey="Chipato, T" uniqKey="Chipato T">T Chipato</name>
</author>
<author><name sortKey="Padian, Ns" uniqKey="Padian N">NS Padian</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Grant, Mj" uniqKey="Grant M">MJ Grant</name>
</author>
<author><name sortKey="Hallman, Kk" uniqKey="Hallman K">KK Hallman</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Becker, Gs" uniqKey="Becker G">GS Becker</name>
</author>
<author><name sortKey="Duesenberry, Js" uniqKey="Duesenberry J">JS Duesenberry</name>
</author>
<author><name sortKey="Okun, B" uniqKey="Okun B">B Okun</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Bronars, Sg" uniqKey="Bronars S">SG Bronars</name>
</author>
<author><name sortKey="Grogger, J" uniqKey="Grogger J">J Grogger</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Chiou, C F" uniqKey="Chiou C">C-F Chiou</name>
</author>
<author><name sortKey="Trussell, J" uniqKey="Trussell J">J Trussell</name>
</author>
<author><name sortKey="Reyes, E" uniqKey="Reyes E">E Reyes</name>
</author>
<author><name sortKey="Knight, K" uniqKey="Knight K">K Knight</name>
</author>
<author><name sortKey="Wallace, J" uniqKey="Wallace J">J Wallace</name>
</author>
<author><name sortKey="Udani, J" uniqKey="Udani J">J Udani</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
</listBibl>
</div1>
</back>
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<article-id pub-id-type="publisher-id">PONE-D-15-17799</article-id>
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<title-group><article-title>Cost-Effectiveness of Introducing the SILCS Diaphragm in South Africa</article-title>
<alt-title alt-title-type="running-head">Cost-Effectiveness of the SILCS Diaphragm</alt-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Lépine</surname>
<given-names>Aurélia</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nundy</surname>
<given-names>Neeti</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kilbourne-Brook</surname>
<given-names>Maggie</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Siapka</surname>
<given-names>Mariana</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Terris-Prestholt</surname>
<given-names>Fern</given-names>
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<xref ref-type="aff" rid="aff001"><sup>1</sup>
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<aff id="aff001"><label>1</label>
<addr-line>Global Health & Development department, London school of hygiene & Tropical Medicine, London, United Kingdom</addr-line>
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<aff id="aff002"><label>2</label>
<addr-line>PATH, Seattle, Washington, United States of America</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Consolaro</surname>
<given-names>Marcia Edilaine Lopes</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>State University of Maringá/Universidade Estadual de Maringá, BRAZIL</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>
MKB and NN are employees of PATH, an international organization that drives transformative innovation to save lives and improve health, especially among women and children (<ext-link ext-link-type="uri" xlink:href="http://www.path.org">www.path.org</ext-link>
). PATH designed and developed the SILCS diaphragm with support from USAID and other donors. PATH has two patents related to the SILCS diaphragm: Contraceptive Diaphragm, US Patent #5771900, and Diaphragm Having a Polymeric Spring Member with Non-Uniform Bending Characteristics, Patent #2045369, which has been issued in France, Germany, UK and China, and is pending in India and Brazil. In 2010 PATH licensed the SILCS technology and related patents for commercialization to Kessel medintim GmbH. PATH has a limited royalty interest in the commercial sales of the SILCS diaphragm to support advocacy for adoption of the SILCS diaphragm in low-resource settings. The PATH authors have no financial interest in SILCS based on the patents or sales. The other authors(s) declare that they have no competing interests. Although there is a patent relating to material pertinent to this article, this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: MKB AL FTP. Performed the experiments: AL NN. Analyzed the data: AL. Contributed reagents/materials/analysis tools: AL MS FTP. Wrote the paper: AL NN MKB FTP.</p>
</fn>
<corresp id="cor001">* E-mail: <email>aurelia.lepine@lshtm.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>21</day>
<month>8</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>10</volume>
<issue>8</issue>
<elocation-id>e0134510</elocation-id>
<history><date date-type="received"><day>24</day>
<month>4</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>9</day>
<month>7</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-year>2015</copyright-year>
<copyright-holder>Lépine et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0134510.pdf"></self-uri>
<abstract><sec id="sec001"><title>Background</title>
<p>Though South Africa has high contraceptive use, unintended pregnancies are still widespread. The SILCS diaphragm could reduce the number of women with unmet need by introducing a discreet, woman-initiated, non-hormonal barrier method to the contraceptive method mix.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>A decision model was built to estimate the impact and cost-effectiveness of the introduction of the SILCS diaphragm in Gauteng among women with unmet need for contraception in terms of unintended and mistimed pregnancies averted, assuming that the available contraceptives on the market were not a satisfying option for those women. Full costs were estimated both from a provider’s and user’s perspective, which also accounts for women’s travel and opportunity cost of time, assuming a 5% uptake among women with unmet contraceptive need. The incremental cost-effectiveness ratio is computed at five and 10 years after introduction to allow for a distribution of fixed costs over time. A probabilistic sensitivity analysis was conducted to incorporate decision uncertainty.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The introduction of the SILCS diaphragm in Gauteng could prevent an estimated 8,365 unintended pregnancies and 2,117 abortions over five years, at an annual estimated cost of US$55 per woman. This comes to a cost per pregnancy averted of US$153 and US$171 from a user’s and provider’s perspectives, respectively, with slightly lower unit costs at 10 years. Major cost drivers will be the price of the SILCS diaphragm and the contraceptive gel, given their large contribution to total costs (around 60%).</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>The introduction of the SILCS diaphragm in the public sector is likely to provide protection for some women for whom current contraceptive technologies are not an option. However to realize its potential, targeting will be needed to reach women with unmet need and those with likely high adherence. Further analyses are needed among potential users to optimize the introduction strategy.</p>
</sec>
</abstract>
<funding-group><funding-statement>Support for this project was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the HealthTech Cooperative Agreement #AID-OAA-A-11-00051. The contents are the responsibility of PATH and the London School of Hygiene and Tropical Medicine and do not necessarily reflect the views of USAID or the US Government.</funding-statement>
</funding-group>
<counts><fig-count count="5"></fig-count>
<table-count count="2"></table-count>
<page-count count="14"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>We confirm that all relevant data are within the paper and Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>We confirm that all relevant data are within the paper and Supporting Information files.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Washington (État)</li>
</region>
<settlement><li>Londres</li>
</settlement>
</list>
<tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Lepine, Aurelia" sort="Lepine, Aurelia" uniqKey="Lepine A" first="Aurélia" last="Lépine">Aurélia Lépine</name>
</region>
<name sortKey="Siapka, Mariana" sort="Siapka, Mariana" uniqKey="Siapka M" first="Mariana" last="Siapka">Mariana Siapka</name>
<name sortKey="Terris Prestholt, Fern" sort="Terris Prestholt, Fern" uniqKey="Terris Prestholt F" first="Fern" last="Terris-Prestholt">Fern Terris-Prestholt</name>
</country>
<country name="États-Unis"><region name="Washington (État)"><name sortKey="Nundy, Neeti" sort="Nundy, Neeti" uniqKey="Nundy N" first="Neeti" last="Nundy">Neeti Nundy</name>
</region>
<name sortKey="Kilbourne Brook, Maggie" sort="Kilbourne Brook, Maggie" uniqKey="Kilbourne Brook M" first="Maggie" last="Kilbourne-Brook">Maggie Kilbourne-Brook</name>
</country>
</tree>
</affiliations>
</record>
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