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Counting the costs: comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa.

Smit J, Gray A, McFadyen L, Zuma K - BMC Health Serv Res (2001)

Bottom Line: 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.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).Providing IPCs on the basis of age is not appropriate or cost effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Africa Centre for Population Studies and Reproductive Health, Mtubatuba, South Africa. jensmit@mweb.co.za

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.

Show MeSH
Ratio of NET-EN:DMPA issued from the four pharmaceutical depots in 1997/8, 1998/9, 1999/2000
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Related In: Results  -  Collection


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Figure 1: Ratio of NET-EN:DMPA issued from the four pharmaceutical depots in 1997/8, 1998/9, 1999/2000

Mentions: The ratios of NET-EN:DMPA issued from the 4 depots were calculated based on CYP rather than on number of vials issued. As shown in Figure 1, DMPA was increasingly used in Port Elizabeth where the ratio of NET-EN:DMPA decreased from 0.64 in 1997/8 to 0.57 in 1999/2000. In Free State the market share was more or less stable (0.42, 0.44, 0.40). A similar picture emerged in KZN (0.22, 0.23, 0.25), with some increase in NET-EN use. However, in Gauteng, while DMPA was still used most, NET-EN use was clearly increasing (0.67, 0.73, 0.81).


Counting the costs: comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa.

Smit J, Gray A, McFadyen L, Zuma K - BMC Health Serv Res (2001)

Ratio of NET-EN:DMPA issued from the four pharmaceutical depots in 1997/8, 1998/9, 1999/2000
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC32302&req=5

Figure 1: Ratio of NET-EN:DMPA issued from the four pharmaceutical depots in 1997/8, 1998/9, 1999/2000
Mentions: The ratios of NET-EN:DMPA issued from the 4 depots were calculated based on CYP rather than on number of vials issued. As shown in Figure 1, DMPA was increasingly used in Port Elizabeth where the ratio of NET-EN:DMPA decreased from 0.64 in 1997/8 to 0.57 in 1999/2000. In Free State the market share was more or less stable (0.42, 0.44, 0.40). A similar picture emerged in KZN (0.22, 0.23, 0.25), with some increase in NET-EN use. However, in Gauteng, while DMPA was still used most, NET-EN use was clearly increasing (0.67, 0.73, 0.81).

Bottom Line: 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.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).Providing IPCs on the basis of age is not appropriate or cost effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Africa Centre for Population Studies and Reproductive Health, Mtubatuba, South Africa. jensmit@mweb.co.za

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.

Show MeSH