Optimizing the Use of 17P In Pregnant Managed Medicaid Members

MANAGED CARE January 2008. ©MediMedia USA

Mary V. Mason, MD, MBA

Senior vice president and chief medical officer, Centene Corp., and clinical assistant professor of medicine, Washington University School of Medicine

Kara M. House, MBA

Director of process optimization, Centene Corp.

Janice Linehan, PA-C, MHP

Medical affairs project specialist, Centene Corp.

Carol A. Speers, RN

Vice president for medical management, Centene Corp.

Lisa M. Joseph, RN, MBA

Director of special product development, Centene Corp.

Ray Littlejohn

Statistician, consultant, and president of the Quest Alliance Inc.

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ABSTRACT

Objective: To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of 16–21 weeks gestation versus after 21 weeks gestation.

Design: A 2004–2007 observational, causal comparative study reviewed birth outcomes in 104 pregnant women with a confirmed history of preterm delivery. Women whose 17P treatment was initiated during the recommended time frame of 16–21 weeks gestation were compared to those whose treatment was initiated after 21 weeks gestation.

Methodology: Intervention included offering 17P as a benefit to pregnant women who had a history of preterm delivery and who were deemed to be appropriate candidates for this treatment by their physician.

Results: No significant changes in birth outcomes were noted when comparing those members whose treatment was initiated during the recommended time frame of 16–21 weeks versus those whose treatment began after 21 weeks gestation. Members who received therapy of at least five injections of 17P, as opposed to those receiving fewer than five injections, experienced a statistically significant reduction in NICU admissions and in preterm birth at fewer than 37 weeks and at fewer than 32 weeks.

Conclusion: The number of injections and not the time frame, which had been indicated by previous research, the initiation of 17P therapy is the factor in reducing preterm birth and decreasing NICU admissions for pregnant women with a history of preterm birth in a managed Medicaid population.

Key Words: Managed Medicaid, preterm birth, 17P, NICU