Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in Nigeria and Ghana.
To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.
Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA. freeflap@gmail.com
Delphine
D
Hu
Daniel
D
Grossman
Carol
C
Levin
Kelly
K
Blanchard
Richard
R
Adanu
Sue J
SJ
Goldie
D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics; D000028:Abortion, Induced / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004107:Dilatation and Curettage / Q000191:economics; D005260:Female; D005869:Ghana; D006801:Humans; D008390:Markov Chains; D016595:Misoprostol / Q000191:economics; D009549:Nigeria; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D014619:Vacuum Curettage / Q000191:economics
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol