Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system

PLoS One. 2024 Mar 28;19(3):e0301207. doi: 10.1371/journal.pone.0301207. eCollection 2024.


High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.

Publication types

  • Review

MeSH terms

  • Brazil
  • Contraceptive Agents, Female* / therapeutic use
  • Delivery of Health Care
  • Desogestrel*
  • Female
  • Humans
  • Intrauterine Devices, Medicated* / adverse effects
  • Levonorgestrel / therapeutic use
  • Pregnancy
  • Quality of Life


  • etonogestrel
  • Levonorgestrel
  • Contraceptive Agents, Female
  • Desogestrel

Grants and funding

The authors received no specific funding for this work. ⦁ Initials of the authors who received each award - THERE WERE NO AWARD ⦁ Grant numbers awarded to each author - THERE WERE NO GRANT ⦁ The full name of each funder - ORGANON BRASIL ⦁ URL of each funder website - ORGANON.COM.BR ⦁ Did the sponsors or funders play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript? LARA LINO, YOHANNA RAMIRES, RICARDO BUENO ALL OF THE ABOVE - WE THREE DECIDED TO PUBLISH, COLLECTED THE DATA, WROTE AND INVITED AGNALDO LOPES TO REVISE AND INPUTS.