TY - JOUR T1 - Economic Evaluation of Provision of Postpartum Intrauterine Device Services in Bangladesh and Tanzania JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 107 LP - 122 DO - 10.9745/GHSP-D-20-00447 VL - 9 IS - 1 AU - Gillian Eva AU - Judy Gold AU - Anita Makins AU - Suzanna Bright AU - Katherine Dean AU - Emily-Anne Tunnacliffe AU - Parveen Fatima AU - Afroja Yesmin AU - Projestine Muganyizi AU - Grasiana F. Kimario AU - Kim Dalziel Y1 - 2021/03/31 UR - http://www.ghspjournal.org/content/9/1/107.abstract N2 - Key FindingsDelivering family planning counseling and offering the immediate postpartum intrauterine device (PPIUD) was found to be cost-effective compared to the standard PPFP practice.The PPIUD program resulted in an incremental cost-effectiveness ratio of US$14.60 per couple years of protection (CYP) and US$91.13 per disability adjusted life year (DALY) averted in Bangladesh and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania.It is likely that national rollout of PPFP counseling and PPIUD delivery will save costs to the health care system in both countries.Key ImplicationsThere is a strong case for governments and donors to invest in providing high-quality family planning counseling during antenatal care and around the time of delivery and to include PPIUD within PPFP provision immediately following delivery.National provision of PPIUD could produce long-term savings in health care costs due to the decrease in unplanned pregnancies resulting from increased PPFP uptake.PPIUD could be even better value if health care providers receive preservice training in this method and if PPIUD delivery was rolled out nationally.Introduction:Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. We assessed the cost-effectiveness of an immediate postpartum intrauterine device (PPIUD) initiative compared with standard practice in Bangladesh and Tanzania (which is no immediate postpartum family planning counseling or service provision) to inform resource allocation decisions for governments and donors.Methods:A decision analysis was constructed to compare the PPIUD program with standard practice. The analysis was based on the number of PPIUD insertions, which were then modeled using the Impact 2 tool to produce estimates of cost per couple-years of protection (CYP) and cost per disability-adjusted life years (DALYs) averted. A micro-costing approach was used to estimate the costs of conducting the program, and downstream cost savings were generated by the Impact 2 tool. Results are presented first for the program as evaluated, and second, based on a hypothetical national scale-up scenario. One-way sensitivity analyses were conducted.Results:Compared to standard practice, the PPIUD program resulted in an incremental cost-effectiveness ratio (ICER) of US$14.60 per CYP and US$91.13 per DALY averted in Bangladesh, and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania. When incorporating estimated direct health care costs saved, the results for Bangladesh were dominant (PPIUD is cheaper and more effective versus standard practice). For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. For the national scale-up model, the results were dominant in both countries.Conclusions/Implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scale-up of PPIUD could produce long-term savings in direct health care costs in both countries. These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies. ER -