Cost-Effectiveness Analysis of Unsafe Abortion and Alternative First-Trimester Pregnancy Termination Strategies in Nigeria and Ghana
), Daniel Grossman(2), Carol Levin(3), Kelly Blanchard(4), Richard Adanu(5), Sue J. Goldie(6),
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(2)
(3)
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(6)
Corresponding Author
Abstract
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 (Afr. J. Reprod. Health 2010; 14[2]: 85-103).
RĖSUMĖ
Analyse du rapport coût-efficacité de l’avortement dangereux et les stratégies de l’interruption de grossesse du premier semestre alterne au Nigéria et au Ghana. Afin d’explorer les implications de la politique de l’augmentation d’accès à l’avortement sans danger au Nigéria et au Ghana, nous avons élaboré un modèle analytique de décision à base informatique qui incite l’avortement provoqué et ses complication chez une cohorte de femmes et nous avons évalué de manière comparative le rapport coût–efficacité de l’avortement dangereux et les trois modalités de l’avortement du premier semestre : la dilatation et le curetage à l’hôpital l’aspiration pneumatique manuel (APM) basé à l’hôpital et à la clinique et l’avortement médical à l’aide de misoprostol (AM). Supposons que toutes les modalités soient disponibles, l’AM est l’option la plus coût–efficacité, au Nigéria. Là où l’APM de la clinique n’est pas disponible, l’AM est la prochaine meilleure stratégie. Par contre, au Ghana l’AM est la meilleure stratégie du coût–efficacité, suivie de l’APM qui est basée à la clinique, au cas où l’AM n’est pas disponible. D’une perspective d’une vraie politique mondiale, l’accès croissant à l’avortement sans danger, au lieu de l’avortement dangereux, constitue le seul facteur le plus important pour sauver la vie et les coûts sociétaux et il est plus influent que le vrai choix de la modalité de l’avortement sans danger (Afr. J. Reprod. Health 2010; 14[2]: 85-103).
KEYWORDS: Abortion, sub-Saharan Africa, cost-effective analysis.
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