Cost-effectiveness of expanding access to intrauterine device provision by nurses in the public health system: an economic decision analysis using a Markov model, Pernambuco, 2023

Abstract

OBJECTIVE: To analyze the cost-effectiveness of increasing the provision and insertion of intrauterine devices following the training of nurses. METHODS: An economic decision analysis using a Markov model was conducted in TreeAge Pro Healthcare 2023 to compare four scenarios in Pernambuco, based on the 2023 population estimate. The current scenario (reference) has a 0.24% provision rate of intrauterine devices. The other scenarios projected increases to 2% (Scenario 1), 3.2% (Scenario 2), and 4% (Scenario 3). Costs related to training and to the distribution of intrauterine devices were analyzed using the absorption costing method. Utilities were estimated based on the literature, adopting the Brazilian willingness-to-pay threshold of up to BRL 40,000.00, allowing flexibility up to BRL 120,000.00 per quality-adjusted life year (QALY). RESULTS: Scenario 1 (2% provision) showed the best cost-effectiveness ratio compared to the current scenario, with an incremental cost of BRL 73,720.20 per QALY gained and benefits observed three months after training. The other scenarios were dominated, meaning that they presented higher costs and lower effectiveness, making them disadvantageous in the short term. CONCLUSION: Expanding the provision to 2% through nurse training is a cost-effective strategy compared to the current level. In addition to optimizing public resources, this measure may reduce the unmet demand for contraception.