[e-drug] cost comparisons injectable contraceptives

[e-drug@usa.healthnet.org]

E-DRUG: cost comparisons injectable contraceptives
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[crossposted from DRUGINFO with thanks. NN]

Hi all

This message has a two-fold purpose - the first is to alert druginfo 
readers to a recently published paper that considers the costs of 
EDL choices in respect of injectable contraceptives (Counting the 
costs: comparing depot medroxyprogesterone acetate and
norethisterone oenanthate utilisation patterns in South Africa. Smit 
JA, Gray AL, McFadyen ML, Zuma K. BMC Health Services 
Research (2001) 1:4 (04 Jun 2001)). The full article is available at 
http://www.biomedcentral.com/1472-6963/1/4/

That's the second point - BioMedCentral is a new, peer-reviewed 
collection of electronic-only journals, on a wide range of biological 
and medical topics. It also offers a number of useful features, eg 
direct links to PubMed abstracts. Worth a look.

The abstract from our paper is appended below. 

regards
Andy
~~~~~~

Abstract 

Background

In South Africa, where health care resources are limited, it is 
important to ensure that drugs provision and use is rational. The 
Essential Drug List includes depot medroxyprogesterone acetate 
(DMPA) and norethisterone oenanthate (NET-EN) as injectable 
progestagen-only contraceptives (IPCs), and both products are 
extensively used.

Objectives and Methods

Utilisation patterns of the injectable contraceptive products DMPA 
and NET-EN are compared in the context of current knowledge of 
the safety and efficacy of these agents. Utilisation patterns were 
analysed by means of a Pareto (ABC) analysis of IPCs issued from 
4 South African provincial pharmaceutical depots over 3 financial 
years. A case study from rural KwaZulu-Natal, South Africa, is 
used to examine utilisation patterns and self-reported side effects 
experienced by 187 women using IPCs.

Results

IPCs accounted for a substantial share of total state expenditure 
on drugs. While more DMPA than NET-EN was issued, NET-EN 
distribution from 2 depots increased over the 3-year period. Since 
DMPA was cheaper, if all NET-EN clients in the 1999/2000 
financial year (annualised) had used DMPA, the 4 depots could 
have saved 4.95 million South African Rands on product acquisition 
costs alone. The KZN case study showed slightly more NET-EN 
(54%) than DMPA (46%) use; no significant differences in self-
reported side effects; and that younger women were more likely to 
use NET-EN than DMPA (p = 0.0001).

Conclusions

Providing IPCs on the basis of age is not appropriate or cost 
effective. Rational use of these products should include 
consideration of the cost of prescribing one over another.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Andy Gray
Discipline Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
email: andy@healthlink.org.za
Tel: +27 31 2044358 Fax: +27 31 2044792


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