Managed Care - January 2008 - (Page 47) Optimizing the Use of 17P In Pregnant Managed Medicaid Members 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. ABSTRACT Objective To evaluate the effect of 17 alphahydroxyprogesterone 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 comAuthor correspondence: Mary V. Mason, MD, MBA Senior Vice President, Chief Medical Officer Centene Corp. 7711 Carondelet Ave. St. Louis, MO 63105 Phone: 314-725-4477 ext 25924 E-mail: mmason@centene.com Fax: 314-725-6176 pared 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 INTRODUCTION Preterm delivery, defined as a delivery before 37 weeks, and the resulting large NICU claims that follow these early births are a large portion of a managed Medicaid company’s expenses. The National Center for Health Statistics’ final birth data for 2005 showed that the preterm birth rate, the percentage of babies born at less than 37 weeks gestation, is continuing to rise, with more than 525,000 babies, or 12.7 percent, born prematurely. That's up from 12.5 percent in 2004. The 2006 preliminary report indicates that the preterm birth rate will continue its upward trend and reach 12.8 percent, about 543,000 babies (Martin 2005). The pathophysiological events that trigger preterm labor are for the most part unknown, but a history of prior spontaneous preterm delivery is one of the strongest risk factors for preterm birth in a subsequent pregnancy (Mercer 1999). A multicenter randomized controlled trial by the National Institute of Child Health and Human Development, published in the New England Journal of Medicine (Meis, 2003) showed that treatment with 17P led to a statistically significant JANUARY 2008 / MANAGED CARE 47
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.