title: Potential cost-effectiveness of universal access to modern contraceptives in Uganda.
abstract: BACKGROUND
  Over two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives.
  
  
  RESULTS
  A Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs. $1,987) and the MoH perspective ($636 vs. $685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis.
  
  
  CONCLUSIONS
  Universal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities.
authors.affiliation: Global Medicines Program, Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, United States of America. babijo@uw.edu
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Gardner
authors.forename: Joseph
authors.initials: J
authors.lastname: Ngonzi
authors.forename: Peter
authors.initials: P
authors.lastname: Mukasa-Kivunike
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D003270:Contraceptive Agents / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005298:Fertility; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D017533:Marital Status; D008390:Markov Chains; D018803:Models, Economic; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011336:Probability; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012725:Sexual Behavior; D014454:Uganda / Q000453:epidemiology
chemical_list: D003270:Contraceptive Agents