Economic analysis of scaling up access to modern family planning methods in low and middle-income countries; case studies for Indonesia and Uganda

Objectives: Family planning is one of the initial strategies to improve maternal health in low and middle-income countries (L-MICs), where unmet need can still be high. The aim of this study was to estimate the cost-effectiveness of improved access to family planning in L-MICs, with Indonesia and Uganda as reference cases. Methods: Our analysis was performed using a Markov decision analytic model, in which the current situation and scenarios to reduce the unmet need for family planning by 25%, 50%, 75% and 100% were incorporated as the comparative strategies. Country-specific evidence was synthesized from the Demographic and Health Survey (DHS) and published studies. The model simulated the natural history of sexual and reproductive health experience of women in reproductive ages over a lifetime time horizon. Modeled outcomes included clinical events, costs and incremental cost effectiveness ratios expressed as cost per disability adjusted life years (ICER per DALYs), unintended pregnancies and maternal deaths averted. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of parameter uncertainty on modeled outcomes. Results: In a hypothetical cohort of 100,000 women, strategies to reduce the unmet need of family planning would result in savings within a range of US$ 210,600 to US$ 832,000 in Indonesia and US$ 538,000 to US$ 2,020,000 in Uganda. DALYs were also estimated to be reduced up to 2% in Indonesia and 9% in Uganda. Further, reductions in pregnancy- related morbidity and mortality were estimated. From a healthcare provider perspective, the incremental analysis indicated that all strategies dominated the current situation in both countries, with lower costs and fewer DALYs. These results were robust in sensitivity analyses. Conclusions: This study provides evidence that reducing the unmet need of family planning may be a dominating strategy, improving health outcomes and at the same time saving costs, in L-MICs with relatively strict budget constraints