ArticleBMJ global health2025
The case for investing in provider-administered subcutaneous DMPA: a costing study.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Moving self-care from concept to practice.BMJ global health · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
introductionDepot medroxyprogesterone acetate (DMPA) is available as provider-administered intramuscular (DMPA-IM) and subcutaneous injections (PA DMPA-SC), as well as DMPA-SC self-injection (SI), which enhances accessibility and continuation by reducing facility visits. However, DMPA-SC has a higher unit price than DMPA-IM, and low SI uptake can undermine its cost-effectiveness. This study assessed whether PA DMPA-SC's potential benefits justify its higher cost compared with DMPA-IM in Malawi, an early SI adopter with a higher proportion of SI.
methodsIn this costing study, we used recursive Markov models to examine 12-month service use patterns and costs for each injectable option. We collected data on supplies and infrastructure supporting injectable services (by product and location: facility or community) through site assessments and group discussions with facility-based providers and community health workers across nine facilities. We derived transition and discontinuation probabilities from longitudinal surveys about service use and experiences in a concurrent cohort study of injectable users aged 15-49.
resultsWe conducted 23 provider group discussions and enrolled 992 cohort participants. PA DMPA-SC users were twice as likely to discontinue their method than DMPA-IM users (HR 2.01 (1.66-2.43)). However, a significantly higher proportion of PA DMPA-SC users transitioned to SI (47.1%), and did so faster, compared with DMPA-IM users (20.4%).The annual DMPA service cost per person-year of use was not substantially different between DMPA-IM (US$11.01) and PA DMPA-SC (US$11.47). Community-based services were 31% lower in cost at US$8.07 than facility-based services at US$11.61.In facilities, DMPA-SC is less expensive than DMPA-IM when 40% or more of all DMPA-SC visits are for SI; for community-based services, the threshold is 23%. Service volume data indicate these thresholds are achievable in Malawi.
conclusionsNot all DMPA-SC users need to self-inject for DMPA-SC to be cost-competitive with DMPA-IM. Use of PA DMPA-SC may increase the uptake of SI over time.
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