Cost-effectiveness of long-acting versus short-acting contraception in adolescents: A systematic review

Fitriya, Yuni and Purnamasari, Arryan Rizqi Aulia and Amalia, Fiki and Astuti, Andari Wuri and Mohd Arifin, Siti Roshaidai and Icanervilia, Ajeng Viska (2025) Cost-effectiveness of long-acting versus short-acting contraception in adolescents: A systematic review. Journal of Health Technology Assessment in Midwifery, 8 (2). pp. 113-125. ISSN 2620-8423 E-ISSN 2620-5653

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Abstract

Child marriage remains a global reproductive health concern, placing adolescents at high risk of early pregnancy and obstetric complications. The selection of effective and cost-efficient contraceptive methods is essential to prevent unintended pregnancies among this vulnerable population. This systematic review aimed to identify and compare the cost-effectiveness of long-acting reversible contraception (LARC) versus short-acting reversible contraception (SARC) among married adolescents. Following PRISMA 2020 guidelines with the PICO framework, we systematically searched PubMed, ScienceDirect, and Google Scholar for studies examining married adolescents aged 10–19 years using LARC methods (IUDs and implants) compared to SARC methods (oral pills, injectables, and condoms). Articles were screened using Rayyan and quality assessed using the CHEERS checklist. Data were narratively synthesized based on parameters including costeffectiveness, cost-utility, cost-benefit, ICER, ACER, and QALY. Of 471 articles identified, six met the inclusion criteria. Most studies employed Markov or decision tree models for economic evaluation. The findings consistently demonstrated that LARC methods were more cost saving compared to SARC across different settings. In Indonesia, IUDs showed an ICER of USD 0.84 per pregnancy averted compared to USD 3.76 for oral pills and USD 5.18 for injectables. In India, etonogestrel implants achieved an ICUR of USD 232 per QALY, well below the national willingness-to-pay threshold. Kenya reported the lowest cost per couple-year of protection for IUDs at USD 4.87. Overall, LARC was shown to prevent more unintended pregnancies at substantially lower costs than SARC, supporting their prioritization in family planning policies to improve access and utilization among married adolescents globally.

Item Type:	Article (Journal)
Uncontrolled Keywords:	Cost-effectiveness; Long-acting reversible contraception; Short-acting reversible contraception; Adolescents;
Subjects:	R Medicine > RG Gynecology and obstetrics R Medicine > RG Gynecology and obstetrics > RG138 Sterilization of women R Medicine > RG Gynecology and obstetrics > RG551 Pregnancy R Medicine > RT Nursing
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Nursing > Department of Special Care Nursing Kulliyyah of Nursing
Depositing User:	Dr. Siti Roshaidai Mohd Arifin
Date Deposited:	23 Jul 2026 07:14
Last Update:	23 Jul 2026 07:14
Queue Number:	2026-07-Q4342
URI:	http://irep.iium.edu.my/id/eprint/130301

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