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Women and children
P88 Ulipristal acetate (UPA) is affordable as emergency contraception (EC) if used where levonorgestrel (LNG) is unlicensed
  1. A B Jones,
  2. L Dominguez Garcia,
  3. C E Cohen,
  4. N Nwokolo,
  5. S L Day
  1. Chelsea and Westminster Hospital, London, UK

Abstract

Background/Aim Our three GUM clinics are increasingly offering an integrated family planning (FP) service. We audited against three Faculty of Sexual and Reproductive Health EC standards. UPA is licensed to be given as EC following an extended window period (<120 h) after unprotected sex (UPSI)) compared to LNG (<72 h) but, is prohibitively more expensive (LNG £6.65, UPA £20.35). We estimated the anticipated cost to our service by introducing UPA to the GUM formulary.

Methods Electronic notes review of patients prescribed EC between 1st December 2010 and 1st March 2011.

Results The case notes of 163 EC prescriptions were reviewed. The median age was 24 years and 58.9% were Caucasian. The Faculty of Sexual and Reproductive Health standards were not achieved (Aim 100%): discuss future contraception (95%); offer STI screening (90%); offer an intrauterine device (Cu-IUD) (54%). 33% (54/163) of patients received a method of general contraception on the day of EC prescription. Of those that did not: 19% (21/109) booked an FP appointment at which 62% received general contraception and 38% did not attend; 12% (13/109) returned for more EC and at one site 4% (2/49) returned pregnant (not EC failures). 4.3% (7/163) of EC prescriptions were outside the product license for LNG but within license for UPA (UPSI 72–120 h ago or multiple episodes of UPSI within 120 h). Using this as an estimate of UPA service need, this equates to an additional expenditure of £383.60/year though, this is likely an underestimate given LNG may not be routinely offered outside its license and is of uncertain efficacy beyond 72 h.

Recommendations Extended provision of Cu-IUD fittings is required to improve offer/uptake rates of this first line EC method—current availability is limited to 1–3 sessions/wk. In light of high default rates clinicians should consider quick starting/dispensing general contraception when prescribing EC. Further FP integration is planned to facilitate this. UPA seems affordable in GUM.

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