Managed Care - January 2008 - (Page 50) TABLE 1 Initiation of treatment P-value 15–21 weeks gestation N N NICU admits Delivery <37 weeks Delivery <32 weeks 47 18 22 12 % 100 38.2 46.8 25.5 Significance 22–34 weeks (2 ξ 2 chi-square gestation one tailed N % statistical test) 57 18 27 8 100 31.5 47.3 14.0 None None None meets the test of statistical significance. Preterm birth The use of five or more 17P injections is associated with statistically significant reductions in the number of preterm births at fewer than 32 weeks (from 61.5 percent to 13.1 percent) and between 33 and 37 weeks (from 76.9 percent to 42.8 percent). Note that 42.8 percent of members had a preterm birth between 33 and 37 weeks and 13.10 percent had a preterm birth at fewer than 32 weeks. Member compliance Of the 1,064 doses scheduled in this series, only 24 doses were missed. A total of 12 members missed the doses. While the 12 accounted for only 2.2 percent of the total number of doses given, they account for over 19 percent of members who delivered and who had infants admitted to the NICU. Note that three members in the non-compliant group were also identified as having received fewer than five injections of the 17P therapy. All three (100 percent) of these members delivered and had infants admitted to the NICU. We find this result compelling. Complications Review of the clinical records for the 104 women in the study group show no complications associated 16 and 21 weeks gestation had a 38.2 percent NICU admission rate while the group initiating treatment with 17P after 21 weeks gestation had 31.50 percent NICU admissions. The mean NICU rate for the whole population was 34.6 percent. This result reflects no significant changes in outcome based on time of initiation of treatment and does not show significant variation from the mean rate of NICU admissions for this population. Preterm birth The group initiating 17P between 16 and 21 weeks gestation had a 46.8 percent rate of preterm birth between 33 and 37 weeks and 25.5 percent rate of preterm birth before 32 weeks. The group initiating treatment with 17P after 21 weeks gestation had a 47.30 percent rate of preterm birth between 33 and 37 weeks and 14 percent rate of preterm birth before 32 weeks. This result reflects no significant changes in outcome based on time of initiation of treatment. Total injection comparison We treated 104 members with 17P; they were the subjects of this review. Thirteen received fewer than five injections (12.5 percent), and 91 received five or more (87.5 percent). Table 2 depicts the results of comparing pregnancy outcomes between the two groups. NICU admissions The application of five or more 17P injections (as opposed to fewer than five injections) is associated with a reduction of NICU admissions from 61.6 percent to 30.7 percent. This drop of 30.9 percentage points is on the order of that found and reported in earlier studies. Specifically, of the 13 members who received fewer than five injections, over 60 percent delivered prematurely. Of these deliveries, 76.9 percent were between 32 and 37 weeks gestation, and over 61 percent of these deliveries were prior to 32 weeks gestation, with fetal demise accounting for one delivery in each category. Ninety-one members received more than five weekly injections of 17P. Of that group, 30.7 percent resulted in an NICU admission. The reduction in NICU admissions, compared to members who received fewer than five injections, TABLE 2 Total Injections P-value Significance (2 ξ 2 chi-square ≥ 5 Injections one tailed N % statistical test) 91 28 39 12 100 30.7 42.8 13.1 P = 0.029 P = 0.021 P = 0.000 < 5 Injections N N NICU admits GA < 37 weeks GA < 32 weeks 13 8 10 8 % 100 61.5 76.9 61.5 50 MANAGED CARE / JANUARY 2008
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