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The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France.

Schmid R - PLoS ONE (2015)

Bottom Line: The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model.In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel.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.

View Article: PubMed Central - PubMed

Affiliation: HRA Pharma, Paris, France.

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 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € 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 € per intake, or 418 € 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.

No MeSH data available.


Related in: MedlinePlus

Decision analytic model.
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pone.0138990.g001: Decision analytic model.

Mentions: A decision-analytical model was developed in TreeAge Pro 2013 (Fig 1). Intrauterine devices were not considered because they are not used as emergency contraception by young women in France, but only used as an option for women aged 35 years and older [8]. The target population is minors aged 15–17 who take emergency contraception. In the base case analysis, emergency contraception intake was within 72 hours, which corresponds to the recommended levonorgestrel dose and indication. The study’s time horizon was the period from unprotected intercourse until the moment termination occurred or, in the case of pregnancy carried to term, within 8 weeks after birth. In line with recommendations from the French guidelines for economic evaluations and cost-effectiveness analysis, a collective perspective was used, attempting to consider all the stakeholders concerned [26]. The collective perspective considers the cost of healthcare resources used whatever the source of funding. In the current analysis, such perspective includes compulsory and supplementary health insurance, as well as governmental funds. In line with the guidance, indirect costs were not included in the collective perspective. The model did not include transportation costs because of a lack of data, whilst costs for loss of productivity were not included because they were not considered relevant in a population of minors.


The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France.

Schmid R - PLoS ONE (2015)

Decision analytic model.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4589416&req=5

pone.0138990.g001: Decision analytic model.
Mentions: A decision-analytical model was developed in TreeAge Pro 2013 (Fig 1). Intrauterine devices were not considered because they are not used as emergency contraception by young women in France, but only used as an option for women aged 35 years and older [8]. The target population is minors aged 15–17 who take emergency contraception. In the base case analysis, emergency contraception intake was within 72 hours, which corresponds to the recommended levonorgestrel dose and indication. The study’s time horizon was the period from unprotected intercourse until the moment termination occurred or, in the case of pregnancy carried to term, within 8 weeks after birth. In line with recommendations from the French guidelines for economic evaluations and cost-effectiveness analysis, a collective perspective was used, attempting to consider all the stakeholders concerned [26]. The collective perspective considers the cost of healthcare resources used whatever the source of funding. In the current analysis, such perspective includes compulsory and supplementary health insurance, as well as governmental funds. In line with the guidance, indirect costs were not included in the collective perspective. The model did not include transportation costs because of a lack of data, whilst costs for loss of productivity were not included because they were not considered relevant in a population of minors.

Bottom Line: The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model.In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel.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.

View Article: PubMed Central - PubMed

Affiliation: HRA Pharma, Paris, France.

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 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € 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 € per intake, or 418 € 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.

No MeSH data available.


Related in: MedlinePlus