TY - JOUR
T1 - Ulipristal acetate compared to levonorgestrel emergency contraception among current oral contraceptive users
T2 - a cost-effectiveness analysis
AU - Bullard, Kimberley A.
AU - Edelman, Alison B.
AU - Williams, Shannon M.
AU - Rodriguez, Maria I.
N1 - Funding Information:
Authors’ disclosures: Kimberley Bullard and Shannon Williams have nothing to disclose. Alison Edelman receives research support from HRA Pharma. This funding is not for ulipristal-acetate- and/or emergency-contraception-related research. Dr. Rodriguez was a Women's Reproductive Health Research fellow; grant 1K12HD085809.☆ Authors’ disclosures: Kimberley Bullard and Shannon Williams have nothing to disclose. Alison Edelman receives research support from HRA Pharma. This funding is not for ulipristal-acetate- and/or emergency-contraception-related research. Dr. Rodriguez was a Women's Reproductive Health Research fellow; grant 1K12HD085809.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Objective: To estimate the cost-effectiveness of ulipristal acetate (UPA) and levonorgestrel (LNG) emergency contraception (EC) on pregnancy prevention among combined oral contraceptive (COC) pill users with an extended pill-free interval. We accounted for the potential interaction of COCs and obesity on EC efficacy. Methods: We built a decision-analytic model using TreeAge software to evaluate the optimal oral EC strategy in a hypothetical cohort of 100,000 twenty-five-year-old women midcycle with a prolonged “missed” pill episode (8–14 days). We used a 5-year time horizon and 3% discount rate. From a healthcare perspective, we obtained probabilities, utilities and costs inflated to 2018 dollars from the literature. We set the threshold for cost-effectiveness at a standard $100,000 per quality-adjusted life-year. We included the following clinical outcomes: number of protected cycles, unintended pregnancies, abortions, deliveries and costs. Results: We found that UPA was the optimal method of oral EC, as it resulted in 720 fewer unintended pregnancies, 736 fewer abortions and 80 fewer deliveries at a total cost savings of $50,323 and 79 additional adjusted life-years. UPA continued to be the optimal strategy even in the case of obesity or COCs impacting UPA efficacy, in which a COC interaction would have to change efficacy of UPA by 160% before LNG was the dominant strategy. Conclusion: Our models found that UPA was the dominant choice of oral EC among COC users with a prolonged “missed” pill episode, regardless of body mass index or an adverse interaction of COCs on UPA. Implications: Ulipristal acetate is the dominant choice of oral emergency contraception among combined oral contraceptive users.
AB - Objective: To estimate the cost-effectiveness of ulipristal acetate (UPA) and levonorgestrel (LNG) emergency contraception (EC) on pregnancy prevention among combined oral contraceptive (COC) pill users with an extended pill-free interval. We accounted for the potential interaction of COCs and obesity on EC efficacy. Methods: We built a decision-analytic model using TreeAge software to evaluate the optimal oral EC strategy in a hypothetical cohort of 100,000 twenty-five-year-old women midcycle with a prolonged “missed” pill episode (8–14 days). We used a 5-year time horizon and 3% discount rate. From a healthcare perspective, we obtained probabilities, utilities and costs inflated to 2018 dollars from the literature. We set the threshold for cost-effectiveness at a standard $100,000 per quality-adjusted life-year. We included the following clinical outcomes: number of protected cycles, unintended pregnancies, abortions, deliveries and costs. Results: We found that UPA was the optimal method of oral EC, as it resulted in 720 fewer unintended pregnancies, 736 fewer abortions and 80 fewer deliveries at a total cost savings of $50,323 and 79 additional adjusted life-years. UPA continued to be the optimal strategy even in the case of obesity or COCs impacting UPA efficacy, in which a COC interaction would have to change efficacy of UPA by 160% before LNG was the dominant strategy. Conclusion: Our models found that UPA was the dominant choice of oral EC among COC users with a prolonged “missed” pill episode, regardless of body mass index or an adverse interaction of COCs on UPA. Implications: Ulipristal acetate is the dominant choice of oral emergency contraception among combined oral contraceptive users.
KW - Contraception
KW - Emergency contraception
KW - Family planning
KW - Levonorgestrel
KW - Missed pills
KW - Ulipristal acetate
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U2 - 10.1016/j.contraception.2019.05.004
DO - 10.1016/j.contraception.2019.05.004
M3 - Article
C2 - 31102631
AN - SCOPUS:85066795725
SN - 0010-7824
VL - 100
SP - 222
EP - 227
JO - Contraception
JF - Contraception
IS - 3
ER -