790: Use of multiple concurrent preterm birth interventions among patients with private versus Medicaid insurance

Abstract

Several interventions are recommended to reduce risk of preterm birth including vaginal progesterone (VP) for women with short transvaginal ultrasound cervical length (TVUS CL), intramuscular 17 alpha-progesterone caproate (17P) in the setting of prior preterm birth, and cerclage for short TVUS CL in the setting of prior preterm birth. Little is known regarding how often women receive concurrent interventions based on insurance status. The objective of this analysis was to characterize receipt of concurrent preterm birth prevention interventions based on Medicaid versus private insurance. A retrospective cohort study using the MarketScan database from 12/2008 to 1/2015 was performed. Marketscan is a claims-based data source that includes privately insured and Medicaid patients. We identified women with an index preterm birth who underwent a subsequent pregnancy. We then determined receipt of the following interventions: (i)17P, (ii) TVUS CL screening, (iii) cerclage, and (iv) VP based on pharmacy receipts for 17P and VP and billing codes for cerclage and TVUS CL screening. The proportion of women receiving >1 intervention was then determined. Overall, 1103 women with an index preterm birth received 17P in a subsequent pregnancy and 1455 received VP. Of women receiving 17P, 13.3% (n=147) received a cerclage, 75.6% received TVUS CL screening, and 7.8% received VP (n=86). Of women receiving vaginal progesterone, 12.0% received cerclage (n=175). Compared to patients with Medicaid receiving 17P, patients with private insurance receiving 17P were significantly more likely to receive concurrent TVUS CL screening (84.3% versus 73.2%, p< 0.01), cerclage (18.2% versus 12.0%, p=0.01), and VP (15.7% versus 5.6%, p< 0.01). Women with a prior preterm birth with private compared to Medicaid insurance were more likely to receive multiple concurrent preterm birth prevention interventions. Comparative effectiveness research evaluating benefit of concurrent interventions is needed to direct clinical care and resource utilization and optimize outcomes.