Résumé
Objetivo: Analisar o impacto orçamentário da adoção de dispositivos contraceptivos reversíveis de longa duração em uma operadora de plano de saúde localizada no Sul do Brasil. Especificamente, analisamos a incorporação do implante subdérmico de etonogestrel (Implanon®) como alternativa ao sistema intrauterino de levonorgestrel (DIU Mirena® ou DIU Kyleena®), ao longo de um período de 15 anos. Métodos: Realizamos uma análise do impacto orçamentário incremental, considerando a inclusão gradual do implante subdérmico de etonogestrel. Foram considerados dados de uma operadora de planos de saúde com mais de 600.000 beneficiários. O horizonte temporal de 15 anos permitiu uma avaliação abrangente dos efeitos financeiros. Resultados: Identificamos 5.345 pacientes elegíveis para a utilização de contraceptivos reversíveis de longa duração. No cenário em que somente o sistema intrauterino de levonorgestrel era adotado, projetou-se um impacto orçamentário total de R$ 746.379.857,80 ao longo de 15 anos. No cenário alternativo, com a incorporação gradual do implante subdérmico, o impacto orçamentário total foi calculado em R$ 689.800.196,83. Isso resultou em um impacto orçamentário incremental negativo de -R$ 56.579.660,97 ao longo do período. Conclusão: A análise de impacto orçamentário realizada indica um potencial benefício financeiro ao adotar o implante subdérmico de etonogestrel como alternativa ao sistema intrauterino de levonorgestrel para contracepção. Esse achado sugere possíveis reduções de custos na área de saúde suplementar no Brasil, reforçando a importância de avaliar opções economicamente viáveis.
Objective: To analyze the budgetary impact of the adoption of long-acting reversible contraceptive devices in a health plan operator located in southern Brazil. Specifically, we analyzed the incorporation of the etonogestrel subdermal implant (Implanon®) as an alternative to the levonorgestrel intrauterine system (Mirena® IUD or Kyleena® IUD), over a period of 15 years. Methods: We performed an analysis of the incremental budgetary impact, considering the gradual inclusion of the etonogestrel subdermal implant. Data from a health plan operator with more than 600,000 beneficiaries were considered. The 15-year time horizon allowed for a comprehensive assessment of the financial effects. Results: We identified 5,345 patients eligible for the use of long-acting reversible contraceptives. In the scenario where only the levonorgestrel intrauterine system was adopted, a total budget impact of BRL 746,379,857.80 was projected over 15 years. In the alternative scenario, with the gradual incorporation of the subdermal implant, the total budgetary impact was calculated at BRL 689,800,196.83. This resulted in a negative incremental budgetary impact of -R$56,579,660.97 over the period. Conclusion: The budget impact analysis carried out indicates a potential financial benefit in adopting the etonogestrel subdermal implant as an alternative to the levonorgestrel intrauterine system for contraception. This finding suggests possible cost reductions in the supplementary healthcare area in Brazil, reinforcing the importance of evaluating economically viable options.
Sujets)
Analyse coût-bénéfice , Contraception , Implant pharmaceutique , Évaluation du Coût-EfficacitéRésumé
Background: Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim: The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting: This study was conducted at a selected primary health care (PHC) facility in KwaZuluNatal. Methods: A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results: Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion: Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions: This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.
Sujets)
Humains , Femelle , Dispositifs contraceptifs , Dispositifs contraceptifs féminins , Services de planification familialeRésumé
Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery.
Résumé
Background: The postpartum period is viewed as an opportune period for uptake of contraception. Ghana has an unmet need for family planning of 30%. This study sought to determine the postpartum Implanon/Nexplanon uptake among women at a tertiary hospital.Methods: This was a retrospective study that analysed 391 Implanon/Nexplanon insertions between 2012 and 2015 at the reproductive health and family planning unit at the Korle-Bu teaching hospital.Results: Almost 69% (391/565) of all Implanon/Nexplanon insertions conducted between 2012 and 2015 were conducted in the postpartum period. Out of these postpartum insertions, 2.3% were done in the immediate postpartum period, 27.6% were done during the interval postpartum period and 70.1% were in the delayed postpartum period. Age and implant insertion status (first time ever or continuing) were significant determinants of postpartum Implanon/Nexplanon insertions. Compared to women less than 20 years of age, women in the age group 20-29 and 30-39 were 76% (AOR=0.24, CI=0.62-0.97) and 80% (AOR=0.20, CI=0.05-0.86) respectively less likely to have postpartum Implanon/Nexplanon insertions done. Continuing users of implant insertions were 45% (AOR=0.55, CI=0.37-0.82) less likely to have post-partum Implanon/Nexplanon insertions done compared to first ever users.Conclusions: There is a high uptake of postpartum Implanon/Nexplanon use among patients who receive implant insertions at the Korle-Bu Teaching Hospital. However immediate postpartum Implanon/Nexplanon insertions are low. There is the need to educate women and couples on the benefits of immediate postpartum implant insertion to avoid rapid repeat pregnancies.
Résumé
Background: Implanon is a single rod implant contraceptive with increasing popularity; however, different views have been expressed by women concerning its use. Aim and Objective: The aim of the study was to evaluate family planning client’s perception and acceptance of implanon as a contraceptive method and the factors affecting its uptake. Study Design/ Methodology: The study used a cross-sectional design consisting of 200 women who visited the family planning clinic of State Specialist Hospital, Akure in Ondo State, Western Nigeria between October and December 2014. Data were collected using self administered questionnaires after obtaining ethical clearance and the clients informed consents. The main outcome measured were awareness of implanon as a method of contraception, source of information about implanon, previous use of implanon and their willingness to accept implanon. Results: The study showed that 54.5% were in the age bracket of 30-39 years and 96% were married. The majority of the women were educated with only 3.5% having no formal education. About 55% had less than 4 children while 45% had 4 or more children. In addition 60% of the women were Christians, 39% practiced Islam while 1% was of other religion. About 69% of the women were already aware of implanon as a contraceptive method with their health care providers being their major source of information. There was a significant association between awareness of implanon with its usage and the health care providers being the source of their information (X2=6.763, P=0.009 and X2 =17.672, P=0.000 respectively). Only 7% of the women had used implanon previously while 24.5% would consider implanon if offered but 75.5% would not. The reasons for this were that insertion and removal could be painful, that it involves a surgical operation and that their husbands may not approve of it. Conclusion: The study showed increased awareness of implanon among our women but this may not translate into its use due to some misconceptions. The findings therefore suggest that additional strategies may be adopted such as the male partner involvement during counselling in order to enhance its use.
Résumé
OBJECTIVE: To determine which mode of ultrasonography (US), among the conventional, spatial compound, and tissue-harmonic methods, exhibits the best performance for the detection of Implanon(R) with respect to generation of posterior acoustic shadowing (PAS). MATERIALS AND METHODS: A total of 21 patients, referred for localization of impalpable Implanon(R), underwent US, using the three modes with default settings (i.e., wide focal zone). Representative transverse images of the rods, according to each mode for all patients, were obtained. The resulting 63 images were reviewed by four observers. The observers provided a confidence score for the presence of PAS, using a five-point scale ranging from 1 (definitely absent) to 5 (definitely present), with scores of 4 or 5 for PAS being considered as detection. The average scores of PAS, obtained from the three different modes for each observer, were compared using one-way repeated measure ANOVA. The detection rates were compared using a weighted least square method. RESULTS: Statistically, the tissue harmonic mode was significantly superior to the other two modes, when comparing the average scores of PAS for all observers (p < 0.00-1). The detection rate was also highest for the tissue harmonic mode (p < 0.001). CONCLUSION: Tissue harmonic mode in uS appears to be the most suitable in detecting subdermal contraceptive implant rods.
Sujets)
Adulte , Femelle , Humains , Adulte d'âge moyen , Analyse de variance , Bras/imagerie diagnostique , Contraceptifs féminins , Désogestrel , Corps étrangers/imagerie diagnostique , Échographie/méthodesRésumé
OBJECTIVE: This study was designed to analyze outcome of removal of non-palpable Implanon(TM) by ultrasound guidance. METHODS: This is retrospective study of patients who were referred from local clinic where removal of non-palpable Implanon(TM) had been failed. The cases were 32 patients who visited to Yonsei University Gangnam Severance Hospital between March 2004 through March 2009. RESULTS: Implanons(TM) were localized on ultrasound in all 32 cases. 18 cases were located in subcutaneous layer, 10 cased were located in fascial layer, 4 cases were located in muscle layer. All cases were successfully removed. The average length of time required for removal was 19.3 minutes. There was no complication except one patient, who had mild median nerve injury. CONCLUSION: Ultrasound guidance removal was safe and effective procedure to remove non palpable Implanon(TM).
Sujets)
Humains , Nerf médian , Muscles , Études rétrospectivesRésumé
Implanon contraceptive medicine was used by 120 women aged 18-40 years old from September 2000 to December 2003. There was no case getting pregnancy. Blood pressure and body weight had not changed significantly. The bleeding pattern had changed in comparing with preferable for women were normal bleeding, spare bleeding and amenorrheoa - 88% -. Side effects manifested with low level and most decreased in comparing with that before the study.