Modeling the cost-effectiveness of social behavior change for family planning in Zambia and Guinea
Summary:
To examine the cost-effectiveness of social and behavior change (SBC) interventions in family planning, we summarized the evidence on the different pathways linking SBC interventions to modern contraceptive use. Results from 130 impact studies and 54 studies with cost data were used to model the potential cost-effectiveness of scaling SBC programming in Zambia and Guinea. For both countries, the models showed that scaling up SBC interventions, in line with government strategies, would lead to substantial increases in modern contraceptive use and reductions in disability-adjusted life years (DALYs). The latter finding met the World Health Organization's threshold for classification as a highly cost-effective intervention. To measure return on investment in SBC, the modeling found that every $1 invested in scaling up SBC interventions in these countries generated cost savings between $2.30 and $6.10, when accounting for direct health care costs and productivity losses averted. While cost-effectiveness and return on investment are not the only considerations for decision-making, these results can inform decisions about whether and how much to invest in SBC and what types of SBC interventions countries should prioritize. Additionally, this analysis identified gaps in the literature where future research on effectiveness and additional cost data collection can contribute to strengthening the knowledge base for SBC programming.
Background/Objectives
Social and behavior change (SBC) interventions that influence attitudes, social norms, and communication are an essential part of high-quality family planning programs. However, little work has been done to systematically connect the pathways by which these interventions lead to increased use of contraception and to measure the associated costs and economic impacts. This understanding can help to ensure that policy makers and programmers appropriately tailor SBC interventions to country specific situations.
Description Of Intervention And/or Methods/Design
We conducted literature reviews to comprehensively summarize evidence for three pathways: (1) the impact of SBC interventions on shifting intermediate outcomes related to contraceptive use, (2) the impact of intermediate outcomes on modern contraceptive use, and (3) the direct impact of SBC interventions on increasing modern contraceptive use. We extracted results from each study, converted results into Odds Ratios (ORs), when necessary, and then categorized results by SBC intervention and outcome. Along with country-specific data related to baseline contraceptive use, attitudes and communication rates, we used the median ORs to model how scaling up different combinations of SBC interventions in Zambia and Guinea would affect contraceptive use and health outcomes. Finally, we combined this work with a parallel effort to synthesize data on the cost of SBC interventions to generate estimates of the cost-effectiveness and return on investment of SBC for these two countries.
Results/Lessons Learned
Collectively, findings from 130 impact studies were summarized as median ORs, ranging from 0.9 to 2.8. SBC costs were drawn from 54 cost studies. Modeling showed that in both Zambia and Guinea, scaling up SBC interventions, in line with government strategies, would lead to substantial increases in modern contraceptive use. Additionally, the models estimated that SBC interventions would cost $1,051 per disability-adjusted life year (DALY) averted in Zambia and $438 per DALY averted in Guinea. These numbers fall below the one time gross domestic product per capita threshold for classification as a highly cost-effective intervention. To measure return on investment, the modeling found that every $1 invested in scaling up SBC interventions generated savings between $2.30 and $6.10, when accounting for direct health care costs and productivity losses averted.
Discussion/Implications For The Field
The results from this innovative work bring together literature on different SBC interventions, outcomes, and costs to demonstrate the cost-effectiveness and return on investment of SBC in family planning. While cost-effectiveness and return on investment are not the only consideration for decision making, these results, taken together with other feasibility and contextual factors, can inform decisions about whether and how much to invest in SBC, and what types of SBC interventions countries should prioritize. Additionally, this analysis identified gaps in the literature where future studies can contribute to expanding and strengthening the knowledge base for future SBC programming.
Abstract submitted by:
James Rosen - Avenir Health
Nicole Bellows - Avenir Health
Lori Bollinger - Avenir Health
Willyanne DeCormier Plosky - Avenir Health
Michelle Weinberger - Avenir Health