Cost-effectiveness of the different contraceptive service provisions in the Ministry of Health facilities in Malaysia

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 large-scale implant provision for Malaysian women in the government health facilities to prevent unintended pregnancies.