Health System Cost of Post-Abortion Care (PAC): A Systematic Review

Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.