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Potential Cost-Effectiveness of Universal Access to Modern Contraceptives in Uganda


  • Joseph B Babigumira
  • Andy Stergachis
  • David L Veenstra
  • Jacqueline S Gardner
  • Joseph Ngonzi
  • Peter Mukasa-Kivunike
  • Louis P Garrison


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. Methodology/Principal Findings: 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 Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources.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. Conclusion/Significance: 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.

Suggested Citation

  • Joseph B Babigumira & Andy Stergachis & David L Veenstra & Jacqueline S Gardner & Joseph Ngonzi & Peter Mukasa-Kivunike & Louis P Garrison, 2012. "Potential Cost-Effectiveness of Universal Access to Modern Contraceptives in Uganda," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-9, February.
  • Handle: RePEc:plo:pone00:0030735
    DOI: 10.1371/journal.pone.0030735

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    References listed on IDEAS

    1. John B. Casterline & Steven W. Sinding, 2000. "Unmet Need for Family Planning in Developing Countries and Implications for Population Policy," Population and Development Review, The Population Council, Inc., vol. 26(4), pages 691-723, December.
    2. Elliot Marseille & James Kahn & Christian Pitter & Rebecca Bunnell & William Epalatai & Emmanuel Jawe & Willy Were & Jonathan Mermin, 2009. "The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda," Applied Health Economics and Health Policy, Springer, vol. 7(4), pages 229-243, December.
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    Cited by:

    1. Simon P S Kibira & Christine Muhumuza & Justine N Bukenya & Lynn M Atuyambe, 2015. "“I Spent a Full Month Bleeding, I Thought I Was Going to Die…” A Qualitative Study of Experiences of Women Using Modern Contraception in Wakiso District, Uganda," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-13, November.
    2. Enden, M.R. & Tolla, M.T. & Norheim, O.F., 2021. "Providing universal access to modern contraceptive methods: An extended cost-effectiveness analysis of meeting the demand for modern contraception in Ethiopia," Social Science & Medicine, Elsevier, vol. 281(C).
    3. Solomon J Lubinga & Esther C Atukunda & George Wasswa-Ssalongo & Joseph B Babigumira, 2015. "Potential Cost-Effectiveness of Prenatal Distribution of Misoprostol for Prevention of Postpartum Hemorrhage in Uganda," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-21, November.
    4. Neily Zakiyah & Antoinette D I van Asselt & Frank Roijmans & Maarten J Postma, 2016. "Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.

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