Cost-effectiveness of increased access to emergency contraceptive pills: probably not

Abstract

In their recent paper, Bayer and colleagues [ [1] Bayer L.L. Edelman A.B. Caughey A.B. Rodriguez M.I. The price of emergency contraception in the United States: what is the cost-effectiveness of ulipristal acetate versus single-dose levonorgestrel?. Contraception. 2013; 87: 385-390 Google Scholar ] argue that efforts to increase use of emergency contraceptive pills (ECPs) containing the active agent ulipristal would be cost-effective because savings from a reduction in unintended pregnancies would outweigh the cost of the drug. However, a systematic literature review published simultaneously on the journal's website suggests otherwise [ [2] Rodriguez M.I. Curtis K.M. Gaffield M.L. Jackson E. Kapp N. Advance supply of emergency contraception: a systematic review. Contraception. 2013; (in press) Google Scholar ]. This review, which essentially duplicated a Cochrane review last updated in 2010 [ [3] Polis C.B. Grimes D.A. Schaffer K. Blanchard K. Glasier A. Harper C.C. Advance provision of emergency contraception for pregnancy prevention (2010 update). Cochrane Database Syst Rev. 2007; : CD005497 Google Scholar ], identified 13 comparative trials that evaluated interventions designed to enhance ECP use by giving the pills to women in advance of need. Although these interventions did increase use, they did not, either individually or collectively, produce any population-level reduction in pregnancy rates. None provided ulipristal-based ECPs, but it is unlikely that the specific compound was a key factor in their lack of success. The price of emergency contraception in the United States: what is the cost-effectiveness of ulipristal acetate versus single-dose levonorgestrel?ContraceptionVol. 87Issue 3PreviewUlipristal acetate (UPA) is a novel form of emergency contraception (EC) that appears to be more effective than the prevailing method, single-dose levonorgestrel (LNG). This study examines the cost-efficacy of UPA compared with LNG. Full-Text PDF Response to Letter to the EditorContraceptionVol. 87Issue 4PreviewWe thank Raymond et al. for their interest in our recent article on the cost-effectiveness of ulipristal acetate (UPA) versus single-dose levonorgestrel (LNG) for emergency contraception (EC) [1]. We agree that no study has yet demonstrated a meaningful population-level reduction in pregnancy rates with LNG EC use, even with advanced provision. However, the studies provided in the response have their own significant limitations, and none definitely evaluates the use of EC at a population level [2���4]. Full-Text PDF