Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Ulipristal acetate (UA) is a novel form of emergency contraception (EC). Preliminary data demonstrates increased efficacy when compared with the current standard, single dose levonorgestrel (LNG). Unlike LNG, UA is currently not available without a prescription. This study examines cost efficacy of UA compared with LNG.
Method: A decision-analytic model was developed to compare cost efficacy of UA versus LNG in preventing unintended pregnancy when taken within 120 hours of unprotected intercourse. Our primary outcome was cost per quality adjusted life year (QALY). QALYs were discounted at a standard 3% rate. UA and LNG failure rates were obtained from a randomized non-inferiority trial and reported as 1.59% and 2.61% respectively. Cost data was obtained from hospital Medicaid payments and the gray literature. Univariate and bivariate sensitivity analyses, as well as Monte Carlo simulation and threshold analyses, were performed.
Result: Utilizing UA instead of LNG would result in 11 fewer pregnancies (UA 15 pregnancies/1000 women; LNG 26 pregnancies/1000 women). This increased efficacy is associated with a cost of $212,611 per QALY gained. At UA’s current market cost of $77, a LNG failure rate of 3% is needed for UA to be cost effective. Sensitivity analysis and Monte Carlo simulations demonstrated that our results are robust.
Conclusion: Despite UA’s superior efficacy in preventing unintended pregnancy, current market costs prohibit standard use. Efforts to reduce UA costs, as seen with over-the-counter status, should be promoted.