TY - JOUR

T1 - Cost-Effectiveness and Cost–Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya

AU - Babagoli, Masih

AU - Benshaul-Tolonen, Anja

AU - Zulaika, Garazi

AU - Nyothach, Elizabeth

AU - Oduor, Clifford

AU - Obor, David

AU - Mason , Linda

AU - Kerubo, Emily

AU - Ngere, Isaac

AU - Laserson, Kayla

AU - Edwards, Rhiannon Tudor

AU - Phillips-Howard, Penelope

PY - 2022/9/15

Y1 - 2022/9/15

N2 - Objective: To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.Design: Cost-effectiveness and cost–benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.Participants: Girls 14–16 years of age enrolled across 30 primary schools in rural western Kenya.Methods: Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.Results: Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: −4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: −4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: −$32,000 to +$169,000).Conclusions: The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.

AB - Objective: To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.Design: Cost-effectiveness and cost–benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.Participants: Girls 14–16 years of age enrolled across 30 primary schools in rural western Kenya.Methods: Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.Results: Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: −4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: −4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: −$32,000 to +$169,000).Conclusions: The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.

KW - adolescence

KW - Cost-Benefit Analysis

KW - Cost-effectiveness analysis

KW - menstrual cup

KW - menstrual health

KW - randomized trial

KW - sanitary pads

U2 - https://doi.org/10.1089/whr.2021.0131

DO - https://doi.org/10.1089/whr.2021.0131

M3 - Article

C2 - 36185073

VL - 3

SP - 773

EP - 784

JO - Women's Health Reports

JF - Women's Health Reports

SN - 2688-4844

IS - 1

ER -