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

摘要

In their recent paper, Bayer and colleagues [1] 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]. This review, which essentially duplicated a Cochrane review last updated in 2010 [3], 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.