Is it worth paying more for emergency hormonal contraception? The cost-effectiveness of ulipristal acetate versus levonorgestrel 1.5 mg

Background and methodology Emergency hormonal contraception (EHC) can reduce unintended pregnancy and the associated costs and consequences for the individual and National Health Service (NHS). Levonorgestrel (LNG 1.5 mg) is currently the standard of care in the UK; however, it is not licensed for use >72 hours after unprotected sexual intercourse (UPSI). This cost-effectiveness analysis compares LNG 1.5 mg with ulipristal acetate (UPA) (ellaOne (R)), a new emergency hormonal contraceptive that is licensed for use up to 120 hours post-UPSI. The costs of both drugs and the costs of the consequences of unintended pregnancy - namely miscarriage, induced abortion and birth - are compared in a decision model from the perspective of the UK NHS. Results The incremental cost-effectiveness ratio (ICER) is the cost of preventing one additional unintended pregnancy with UPA and is calculated to be 311 pound compared to LNG 1.5 mg when taken up to 120 hours post-UPSI. In sensitivity analysis, looking at different time frames and costs, the ICER ranges from 183 pound to 500 pound. All these costs are less than the estimated cost of an unintended pregnancy (948) pound regardless of the outcome or the cost of an induced abortion (672) pound. Discussion and conclusions Even when considering only the direct costs of an unintended pregnancy, UPA represents value for money as a method of EHC when taken up to 120 hours post-UPSI. UPA is a cost-effective alternative to LNG 1.5 mg for all women presenting for EHC.