Pregnancy Outcomes of Managed Medicaid Members Prescribed Home Administration of 17 α-Hydroxyprogesterone Caproate

Abstract

Objective Examine adherence to treatment guidelines and rates of recurrent spontaneous preterm birth (SPTB) in managed Medicaid patients prescribed 17 α-hydroxyprogesterone caproate (17P).

Study Design A retrospective observational study of women receiving 17P between July 2004 and May 2010 through one of Centene's managed Medicaid programs. Included for analysis were singleton pregnancies without cerclage having SPTB history and prescribed 17P by their physician. Compounded 17P was administered through an outpatient program inclusive of patient education, weekly home nurse visits, and 24-7 telephonic nurse access. A health plan–directed pregnancy management program, Start Smart for Your Baby^®, supported the therapy with case management activities.

Results Of the 790 patients studied, 58.6% initiated 17P in the recommended 16- to 20.9-week gestational age window. Elective discontinuation of 17P occurred in 18.6%. Of the 10,583 17P injections administered, 97.5% were administered within the recommended injection interval of 6 to 10 days. Recurrent SPTB occurred in 28.2% of women studied.

Conclusion Managed Medicaid patients enrolled in an outpatient 17P administration program supported with maternal case management have high rates of treatment compliance. Their pregnancy outcomes compare favorably to previously published reports that include both Medicaid and commercially insured patients.

Keywords

17 alpha-hydroxyprogesterone caproate (17P) - recurrent spontaneous preterm birth - Medicaid - managed care - case management

• References

• 1 American Academy of Pediatrics. Fact Sheet: Medicaid and Children. July 10, 2011. Available at: http://www.aap.org/research/factsheet.pdf . Accessed August 23, 2011
• 2 Kaiser Family Foundation. Available at: http://www.statehealthfacts.org . Accessed August 23, 2011
• 3 Kaiser Family Foundation. Policy Brief. Medicaid and managed care: key data, trends and issues. February 2010. Available at: http://www.kff.org/medicaid/upload/8046.pdf . Accessed August 23, 2011
• 4 Mercer BM, Goldenberg RL, Moawad AH , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol 1999; 181 (5 Pt 1) 1216-1221
• 5 Meis PJ, Klebanoff M, Thom E , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348: 2379-2385
• 6 Rittenberg C, Sullivan S, Istwan N, Rhea D, Stanziano G, Newman R. Clinical characteristics of women prescribed 17 alpha-hydroxyprogesterone caproate in the community setting. Am J Obstet Gynecol 2007; 197: 262, e1-e4
• 7 Mason MV, Poole-Yaeger A, Krueger CR, House KM, Lucas B. Impact of 17P usage on NICU admissions in a managed Medicaid population—a five-year review. Manag Care 2010; 19: 46-52
• 8 Mason MV, Poole-Yaeger A, Lucas B, Krueger CR, Ahmed T, Duncan I. Effects of a pregnancy management program on birth outcomes in managed Medicaid. Manag Care 2011; 20: 39-46
• 9 Rebarber A, Fox NS, Klauser CK , et al. Using 17 α-hydroxyprogesterone caproate to impact rates of recurrent preterm delivery in clinical practice. J Matern Fetal Neonatal Med 2010; 23: 1139-1142
• 10 González-Quintero VH, Istwan NB, Rhea DJ, Smarkusky L, Hoffman MC, Stanziano GJ. Gestational age at initiation of 17-hydroxyprogesterone caproate (17P) and recurrent preterm delivery. J Matern Fetal Neonatal Med 2007; 20: 249-252
• 11 How HY, Barton JR, Istwan NB, Rhea DJ, Stanziano GJ. Prophylaxis with 17 alpha-hydroxyprogesterone caproate for prevention of recurrent preterm delivery: does gestational age at initiation of treatment matter?. Am J Obstet Gynecol 2007; 197: 260, e1-e4
• 12 Mason MV, House KM, Linehan J, Speers CA, Joseph LM, Littlejohn R. Optimizing the use of 17P in pregnant managed Medicaid members. Manag Care 2008; 17: 47-52
• 13 Rebarber A, Ferrara LA, Hanley ML , et al. Increased recurrence of preterm delivery with early cessation of 17-alpha-hydroxyprogesterone caproate. Am J Obstet Gynecol 2007; 196: 224, e1-e4
• 14 Mason MV, House KM, Fuest CM, Fitzgerald DR, Kitson BJ, Inglis JA. 17 alpha-hydroxyprogesterone caproate (17P) usage in a Medicaid managed care plan and reduction in neonatal intensive care unit days. Manag Care 2005; 14: 58-63