P092Measuring utilization of mifepristone in medication management of missed abortions: Retrospective claims analysis study

Abstract

<h3>Objectives</h3> Characterize the use of mifepristone with misoprostol for the medical management of missed abortion in the US. <h3>Methods</h3> We conducted a retrospective cohort study utilizing IBM MarketScan® employer-sponsored healthcare claims database between January 1, 2016 and December 31, 2019. We identified a cohort of women aged 14–54 undergoing medical management of missed abortion using ICD-10 codes from outpatient service codes and prescription claims. We used prescription claims to identify utilization of monotherapy (misoprostol alone) or combination therapy (mifepristone and misoprostol). Our primary outcome was the proportion of missed abortions managed medically using combination therapy. We employed logistic regression to assess the association of the primary outcome with geographic region and a binary categorical variable for whether the prescription was filled before or after the American College of Obstetricians and Gynecologists (ACOG) updated guidelines to recommend the use of combination therapy. <h3>Results</h3> There were 20,508 cases of medically managed missed abortion included in the cohort. Combination therapy was used in 0.7% (n=141) while 99.3% (n=20,367) were treated with monotherapy. In multivariable analysis, receiving treatment after the ACOG guideline update (OR, 2.22; CI, 1.58–3.13) and in the West (OR, 8.62, CI, 4.69–15.81) or Northeast (OR, 15.29; CI, 8.46–27.65) were associated with increased odds of receiving combination therapy. <h3>Conclusions</h3> Very few women in our cohort received the more efficacious combination therapy. The availability of mifepristone is likely a barrier to routine utilization. Efforts to increase the use of combination therapy are needed.