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


OBJECTIVE
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.
Smit
J
J
Africa Centre for Population Studies and Reproductive Health, Mtubatuba, South Africa. jensmit@mweb.co.za
Gray
A
A
McFadyen
L
L
Zuma
K
K
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002755:Choice Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000600:supply & distribution; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data*; D018954:Drugs, Essential / Q000191:economics / Q000600:supply & distribution; D005260:Female; D005298:Fertility / Q000187:drug effects; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007267:Injections / Q000191:economics; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000600:supply & distribution; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics* / Q000600:supply & distribution; D010594:Pharmacies / Q000191:economics; D013019:South Africa; D016896:Treatment Outcome
D003271:Contraceptive Agents, Female; D018954:Drugs, Essential; D017258:Medroxyprogesterone Acetate; C024319:norethindrone enanthate; D009640:Norethindrone