See related article by Christofield and Lacoste.
In a recently published article in Global Health: Science and Practice, “Accessible contraceptive implant removal services: an essential element of quality service delivery and scale-up,” Christofield and Lacoste emphasized the growing unmet need for quality implant removal services.1 The authors projected the numbers of implant removals in 69 Family Planning 2020 (FP2020) focus countries to more than double between 2015 and 2018 (from 2.2 million to between 4.9 and 5.8 million). The Implant Removal Task Force of the Implants Access Program Operations Group is developing best practices and solutions to meet this increasing demand.
In addition to the sheer numbers of implants that will require removal in coming years, the cost of removal services must also be considered. To begin to understand this impending resource need, we conducted a modeling exercise to forecast potential demand for contraceptive implant removals between 2016 and 2020 in the 5 countries with the highest levels of implant procurement in 2015 (Tanzania, Nigeria, Ethiopia, Kenya, and Zambia).2 We then applied a direct cost (supplies and labor) of US$2.41 per removal derived from projections based on previously developed cost estimates for Kenya.3
Our analysis differed from Christofield and Lacoste in 2 ways:
Instead of assuming all implants are removed at the end of the implants' couple-years of protection (2.5 years to 3.2 years depending on the type of implant), we calculated the number of expected removals per year using cumulative discontinuation rates reported in the most recent Cochrane review assessing …
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