The price of emergency contraception in the United States: what is the cost-effectiveness of ulipristal acetate versus single-dose levonorgestrel?

Contraception. 2013 Mar;87(3):385-90. doi: 10.1016/j.contraception.2012.08.034. Epub 2012 Oct 4.


Background: Ulipristal 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.

Study design: A decision-analytic model was developed to compare the cost-effectiveness of UPA versus LNG in preventing unintended pregnancy when taken within 120 h of unprotected intercourse. Univariate and bivariate sensitivity analyses, as well as Monte Carlo simulation and threshold analyses, were performed.

Results: Utilizing UPA instead of LNG would result in 37,589 fewer unintended pregnancies per 4,176,572 estimated US annual EC uses (UPA 54,295 pregnancies; LNG 91,884 pregnancies) and a societal savings of $116.3 million annually. Cost-effectiveness acceptability curve analyses suggest a 96% probability that UPA is more cost-effective at a willingness to pay $100,000 per quality-adjusted life year.

Conclusions: UPA is cost-effective in preventing unintended pregnancy after unprotected intercourse. Efforts should be promoted to increase access to UPA.

Publication types

  • Comparative Study

MeSH terms

  • Contraception, Postcoital / economics*
  • Contraceptive Agents, Female / administration & dosage
  • Contraceptive Agents, Female / economics*
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Humans
  • Levonorgestrel / administration & dosage
  • Levonorgestrel / economics*
  • Monte Carlo Method
  • Norpregnadienes / administration & dosage
  • Norpregnadienes / economics*
  • Pregnancy
  • Pregnancy, Unplanned*
  • United States


  • Contraceptive Agents, Female
  • Norpregnadienes
  • Levonorgestrel
  • ulipristal acetate