Abstract
OBJECTIVE: To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. METHODS: The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates outcomes of unintended pregnancies and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The cost of an unintended pregnancy in a French minor is estimated to be 1630 euro (range 1330 euro - 1803 euro). Almost 4 million euro (3.1 euro - 13.7 euro million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 euro per intake or 418 euro per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. CONCLUSIONS: Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse i.e. it is more effective at a lower cost. When taken within 72 hours ulipristal acetate is a cost- effective alternative to levonorgestrel given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings it is worthwhile to provide free access to minors.
Highlights
Preterm birth (PTB) complications are estimated to be the second most common cause of death in under-five children and responsible for 3.1million neonatal deaths
When 3 months of ulipristal acetate therapy was compared with immediate hysterectomy, the incremental cost-effectiveness ratio was reduced to 2,300 € /quality-adjusted life years (QALYs)
Treatment with progesterone is one of the interventions recommended for PTB prevention due to the evidence supporting its efficacy in women with short cervix and prior history of preterm delivery
Summary
Children undergoing cardiac surgery for congenital heart disease are more likely to experience development of acute kidney injury (AKI) in the immediate postoperative period. AKI diagnosis is based on a rise in serum creatinine (sCr) levels, which occurs 2-3 days after the initiating renal insult. Many new biomarkers offer promise for earlier AKI diagnosis.
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