PDG3 EVALUATION OF PROGESTERONE (17-ALPHA HYDROXYPROGESTERONE CAPROATE (17-OHPC)) UTILIZATION, ADHERENCE, AND OUTCOMES IN WOMEN WITH A HIGH-RISK PREGNANCY

Abstract

Preterm birth (PTB) is the most common cause of neonatal morbidity and mortality. The study objectives were to investigate 17-OHPC use among eligible women, assess medication adherence, and evaluate outcomes in preventing PTB in a real-world setting. The Decision Resources Group (DRG) database (1/1/2012–12/31/2017) was used. Women with >=1 ICD-9-CM/ICD-10-CM diagnosis of “history of preterm labor,” 16-50 years old, with singleton gestation, continuously enrolled >=6 months before the index date, had delivery outcome recorded, and did not have a short cervix or cerclage were included. Adherence was defined as (1) receipt of >=10 17-OHPC injections, and (2) number of injections/eligible number of injections >0.7. Incidence of PTB was evaluated as the outcome. Bivariate tests compared patients’ characteristics in their utilization, adherence, and outcome of 17-OHPC. Logistic regression was applied to evaluate the outcome. Of 23,911 eligible patients, 2,051 (8.6%) had >=1 17-OHPC claim. The utilization rate showed an increasing trend, from 5.58% (2012) to 21.97% (2017). Commercial insurance patients were more likely to use 17-OHPC than Medicaid patients (p<0.0001). Of those prescribed 17-OHPC, 407 (19.8%) were adherent. Patients >35 years were 34% less likely to have PTB than patients <25 years (OR=0.66, 95%CI=0.59-0.74); patients residing in the Southeast US were 12% less likely to have PTB than Northeast patients (OR=0.64, 95%CI=0.54-0.75); patients with hypertension were 15% more likely to have PTB (OR=1.15, 95%CI=1.02-1.29); patients with CCI>=3 were 35% more likely to have PTB than patients with CCI=0 (OR=1.35, 95%CI=1.17-1.56). After controlling for covariates, no association was found between the incidence of PTB and utilization of (p=0.44) or adherence to (p=0.14) 17-OHPC. 17-OHPC use was <10%, adherence was low, and there was no evidence of effectiveness. Utilization of 17-OHPC was associated with insurance type and geographic region. No association was found between patients’ adherence and their demographic or clinical characteristics.