投资供应商管理的皮下DMPA的理由:一个成本评估研究
Holly M Burke1, Wingston Felix Ng'ambi2, Rick Homan3
1Contraceptive Research, Development, and Introduction, FHI 360, Durham, North Carolina, USA hburke@fhi360.org.
BMJ global health
|October 23, 2025
概括
在马拉维,供应商管理的皮下DMPA (PA DMPA-SC) 与肌内DMPA (DMPA-IM) 的成本竞争力. 与PA DMPA-SC一起增加自我注射 (SI) 的吸收可以提高成本效益.
科学领域:
- 生殖健康 生殖健康
- 卫生经济学 卫生经济学
- 公共卫生干预措施 公共卫生干预措施
背景情况:
- 德波特美德乙酸 (DMPA) 可提供肌内 (DMPA-IM) 和皮下 (DMPA-SC) 配方.
- DMPA-SC提供供应商管理的 (PA DMPA-SC) 和自我注射 (SI) 选项,旨在提高可访问性和延续性.
- 与DMPA-IM相比,DMPA-SC的更高的单位成本和可变的SI吸收影响了其成本效益.
研究的目的:
- 评估PA DMPA-SC相对于马拉维的DMPA-IM的成本效益.
- 评估自我注射 (SI) 吸收对DMPA-SC.的成本效益的影响.
主要方法:
- 一项使用递归马尔科夫模型分析12个月服务使用和成本的成本研究.
- 通过现场评估,与医疗保健提供者进行小组讨论以及对注射使用者的纵向调查来收集数据.
- 从同步的队列研究中推导过渡和停止概率.
主要成果:
- 与DMPA-IM使用者 (20.4%) 相比,PA DMPA-SC使用者的戒断率更高 (HR 2.01),但SI过渡率 (47.1%) 显著更高.
- 每个年的人均DMPA服务成本相似:DMPA-IM (11.01美元) 和PA DMPA-SC (11.47美元).
- 基于社区的服务比基于设施的服务 (11.61美元) 便宜 (8.07美元). 当SI采用率达到40% (设施) 或23% (社区) 时,DMPA-SC与DMPA-IM具有成本竞争力.
结论:
- 在没有通用自我注射的情况下,PA DMPA-SC可以与DMPA-IM具有成本竞争力.
- 自我注射 (SI) 的吸收可能会随着PA DMPA-SC.的使用而增加.
- 马拉维可实现的SI吸收门支持DMPA-SC的成本竞争力.
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