Counting the costs: Comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South AfricaReport as inadecuate

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BMC Health Services Research

, 1:4

First Online: 04 June 2001Received: 16 March 2001Accepted: 04 June 2001DOI: 10.1186-1472-6963-1-4

Cite this article as: Smit, J., Gray, A., McFadyen, L. et al. BMC Health Serv Res 2001 1: 4. doi:10.1186-1472-6963-1-4


BackgroundIn South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate DMPA and norethisterone oenanthate NET-EN as injectable progestagen-only contraceptives IPCs, and both products are extensively used.

Objectives and MethodsUtilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents. Utilisation patterns were analysed by means of a Pareto ABC analysis of IPCs issued from 4 South African provincial pharmaceutical depots over 3 financial years. A case study from rural KwaZulu-Natal, South Africa, is used to examine utilisation patterns and self-reported side effects experienced by 187 women using IPCs.

ResultsIPCs accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from 2 depots increased over the 3-year period. Since DMPA was cheaper, if all NET-EN clients in the 1999-2000 financial year annualised had used DMPA, the 4 depots could have saved 4.95 million South African Rands on product acquisition costs alone. The KZN case study showed slightly more NET-EN 54% than DMPA 46% use; no significant differences in self-reported side effects; and that younger women were more likely to use NET-EN than DMPA p = 0.0001.

ConclusionsProviding IPCs on the basis of age is not appropriate or cost effective. Rational use of these products should include consideration of the cost of prescribing one over another.

List of AbbreviationsCYPcouple years of protection

DMPAdepot medroxyprogesterone acetate

EDLessential drugs list


IPCsinjectable progestagen-only contraceptives

NET-ENnorethisterone oenanthate

SARSouth African Rand

WHOWorld Health Organisation

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-1-4 contains supplementary material, which is available to authorized users.

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Author: Jennifer Smit - Andrew Gray - Lynn McFadyen - Khangelani Zuma


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