Evaluating the potential cost-effectiveness of integrating contraceptive microarray patches into the contraceptive product mix in three low- and middle-income countries

Unmet need for contraceptives still exists within low- and middle-income countries (LMICs). New innovations under development such as the hormonal contraceptive microarray patch (MAP) hold the potential to address some of the reasons for the unmet need, but their value proposition has not been determined. We conducted an analysis to evaluate the potential cost-effectiveness of adding MAPs to the contraceptive product mix in three LMICs. The analyses were done for Ghana, Nepal, and Senegal, countries with high levels of unmet need. Our analysis evaluated the impact and costs of MAPs meeting a proportion of unmet need for contraceptives, considering various MAP product attributes such as MAP price (range from US$1.65 to US$4.00), market share, and failure rates, among others. Secondary data were used to inform model inputs and assumptions. One-way and probabilistic sensitivity analyses were conducted on key model inputs. Costs and outcomes were evaluated over a 1-year period with reference year 2020. The analysis was done from the health system and limited society perspectives. The per capita gross domestic product (GDP) was the threshold to evaluate cost-effectiveness and was US$2,177, US$1,139, and US$1,490 for Ghana, Nepal, and Senegal, respectively. With the contraceptive MAP available, and assuming a six-month duration of effectiveness and that 1% of women with unmet need and 1% of current users switch to the contraceptive MAP, we estimated a reduction in pregnancies that would avert 664, 1,076, and 288 disability-adjusted life years, for Ghana, Nepal, and Senegal, respectively, and with cost savings. Cost-effectiveness is impacted by MAP duration of effectiveness, price, and the pregnancy management costs. These findings suggest that the use of new innovations such as MAPs in LMICs has the potential to be cost saving or cost-effective depending on MAP target product attributes and increased use of contraceptives by those with unmet need.