Determination of the Cost-effectiveness of Contraceptive Methods Offered in Kiambu County Hospital, Kenya

Abstract

Background: In 2014, Kenya had a Contraceptive Prevalence Rate (CPR) of 53% (modern methods) among married women and required about Kenya Shillings (KeS) 30 Billion (300 Million USD) between 2017 and 2020 to increase the CPR to 58% (a target chosen by the country). Investing in the more cost-effective contraceptive methods would ensure higher benefits without additional cost. Several studies conducted mainly in developed countries have shown that long-acting methods are more cost-effective than short-acting methods. This may not be the case in developing countries, like Kenya. Objective: The overall objective of this research was to determine the cost-effectiveness of the four main contraceptive methods provided in Kiambu County Hospital, from the hospital perspective. Methodology: This was a cross-sectional study undertaken in the hospital. A purposeful sampling of healthcare providers and systematic sampling of the first 15 service delivery sessions of each method; IUCD, Implants, DMPA and CoC Pills, was done. The cost was determined using activity-based costing model with labour, overheads, equipment, capital and workload as the dependent variables and then divided by Couple Years Protection (CYP) conversion factors (independent variables) associated with each method. The contraceptive methods with lower cost of service delivery per CYP were deemed to be more cost-effective. Result: The IUCD was found to be the most cost-effective contraceptive method at KeS 502 per CYP, followed by the 2-Rod Implant at KeS 655, the 1-Rod Implant at KeS 979, and DMPA at KeS 2,439. The CoC Pills were the least cost-effective at KeS 3,977 per CYP. The initial cost of providing each of the four methods was highest for the 2-Rod Implant, followed by 1-Rod Implant, IUCD and DMPA, while CoC Pills attracted the least cost. Conclusion: Long-term methods were found to be more cost-effective than short-term methods despite having higher initial cost of service delivery. Investing in long-acting methods is an efficient way of using resources allocated to contraceptive services.