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Between August 2017 and July 2018, 9,073 pregnant women received PPIUD\/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25\/PPIUDs and $77\/PP implant. Costs per CYP were $6\/PPIUDs and $21\/PP implant.\u00a0\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion:<\/ns4:bold>\n                    Understanding the cost per PPIUD\/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD\/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.\n                  <\/ns4:p>","DOI":"10.12688\/gatesopenres.12858.4","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T11:35:09Z","timestamp":1582889709000},"page":"39","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda"],"prefix":"10.12688","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2004","authenticated-orcid":false,"given":"Kristin M.","family":"Wall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosine","family":"Ingabire","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9150-3898","authenticated-orcid":false,"given":"Susan","family":"Allen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"Karita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2020,2,28]]},"reference":[{"key":"ref-1","article-title":"Adding it up: Investing in Contraception and Maternal and Newborn Health, 2017","year":"2017"},{"key":"ref-2","article-title":"Report of a technical consultation on 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T10:55:11Z","timestamp":1591095311000},"score":1,"resource":{"primary":{"URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,28]]},"references-count":49,"URL":"https:\/\/doi.org\/10.12688\/gatesopenres.12858.4","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/gatesopenres.14293.r28636","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/gatesopenres.14293.r28636","asserted-by":"object"}]},"ISSN":["2572-4754"],"issn-type":[{"value":"2572-4754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,28]]},"assertion":[{"value":"Indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.13941.r26628, Katherine Tumlinson, Department\u00a0of\u00a0Maternal\u00a0and\u00a0Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 03 Sep 2018, version 1, 1 approved with reservations, 1 not approved","URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v1#referee-response-26628","order":0,"name":"referee-response-26628","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14293.r28636, Kate H. Rademacher, FHI 360, Durham, NC, USA, 14 Apr 2020, version 4, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4#referee-response-28636","order":1,"name":"referee-response-28636","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.14061.r27631, Aisha N.Z. Dasgupta, United Nations Population Division, New York, NY, USA, 09 Sep 2019, version 3, 3 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v3#referee-response-27631","order":2,"name":"referee-response-27631","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kristin Wall<\/b>; \n<i>Posted: 26 Feb 2020<\/i>; We appreciate these thoughtful comments which have further improved the manuscript.In the introduction, we clarify that the estimate of 51% unmet need is based on a prospective assessment as a less biased means to predict women\u2019s family planning need in the postpartum period. We now highlight in the introduction the sizeable opportunity to provide PPFP counseling\/services at timepoints when women are already engaged in the healthcare system. The CYP for the contraceptive methods are now calculated adjusting to remove any \u2018double coverage\u2019 caused by overlap with post-partum insusceptibility, and we discuss changes in postpartum pregnancy risk as well as frequency of breastfeeding, LAM, and periodic abstinence in this population. Reimbursements for providers&nbsp;were higher for the IUD versus the implant because IUD insertion required additional training and certification time and each IUD takes longer to insert versus an implant. For further context, we now describe (as reported previously and in an upcoming publication), of women to whom we promoted PPFP to who delivered at a study facility, 11% selected the implant and 29% the selected the IUD. The average age and parity of women selecting the IUD or implant, as well as frequency of removals, side-effects, pain\/anxiety during insertion, and satisfaction are now reported. An improved understanding of differences in women who uptake the IUD versus implant (versus another method entirely) would be informative for future scale-up, as now mentioned. We clarify that the driver of the difference in implant versus IUD costs are commodity costs. The wide range of cost per CYP estimates from other studies are related to variation across countries in costs of trainings; consumable supplies; instruments; and labor for counseling, insertion, removal, and resupply.","URL":"https:\/\/gatesopenresearch.org\/articles\/2-39\/v4#referee-comment-3295","order":3,"name":"referee-comment-3295","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Bill & Melinda Gates Foundation [OPP1160661]. Additional support came from the Emory University Research Council Grant [URCGA16872456], Emory Global Field Experience Award, the Emory Center for AIDS Research [P30 AI050409], the National Institutes of Health [NIAID R01 AI51231; NIAID R01 AI64060; NIAID R37 AI51231], Emory AITRP Fogarty [5D43TW001042], and the International AIDS Vaccine Initiative (IAVI) [SOW2166]. The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}