Cost-effectiveness analysis of self-injectable versus health worker-administered injectable contraceptive modalities among women of reproductive age (15-49 years) at Kajjansi Health Center IV Wakiso District

Abstract

Background: Globally, injectable contraceptives are valued for their safety and convenience, with self-injection further enhancing accessibility. However, the cost-effectiveness of self-injectables compared to intramuscular methods remains unclear. This study assessed the cost-effectiveness of self-injectable versus health worker-administered DMPA to evaluate its economic and practical benefits. Objectives: To assess the incremental costs, effectiveness, and cost-effectiveness of self-injectable versus health worker-administered injectable contraceptive modalities among women aged 15-49 at Kajjansi Health Center IV. Methods: The study compared self-injectable and health worker-administered contraceptive modalities over a one-and-a-half-year period using a Decision Tree model from a societal perspective. Costs were estimated by identifying and valuing resources for each modality, while effectiveness was measured in terms of unintended pregnancies averted. Incremental cost-effectiveness ratio (ICER) calculations and sensitivity analyses were conducted to assess robustness under different scenarios and willingness-to-pay (WTP) thresholds. Results: The self-injectable contraceptive method had a total cost of $557 and prevented 145 pregnancies, while the health worker-administered method cost $527 and prevented 140 pregnancies. The incremental cost-effectiveness ratio (ICER) of 750 indicates that self-injection provides greater effectiveness for a modest cost increase. Sensitivity analysis confirmed the stability of the results across various scenarios, supporting the cost-effectiveness of the self-injectable method. Conclusions and Recommendations: Self-injection was a more cost-effective contraceptive modality, preventing more unintended pregnancies at a slightly higher cost compared to health worker-administered injections. These findings provide evidence to support resource allocation decisions and improvements in contraceptive modalities at Kajjansi Health Center IV and similar settings.