Managing perinatal outcomes: the clinical benefit and cost-effectiveness of pharmacologic treatment of recurrent preterm labor.
OBJECTIVE
To compare the clinical benefit and cost-effectiveness of utilizing continuous subcutaneous terbutaline versus oral tocolytics following recurrent preterm labor.


METHODS
Retrospective, 1:1 matched cohort.


METHODS
From prospectively collected data in a nationwide, perinatal database of women receiving outpatient services, we identified singleton gestations having recurrent preterm labor, stabilized during hospitalization, and subsequently treated with oral tocolytics (PO group) or continuous subcutaneous terbutaline infusion (SQ group). Those without medically indicated delivery were eligible for inclusion. Each woman in the PO group was matched 1:1 by gestational age at recurrent preterm labor to a woman in the SQ group. A standardized cost model was applied to compare total antepartum hospital, nursery, and outpatient charges. Wilcoxon Signed Rank, paired t, and McNemar's C2 test statistics were used for comparisons.


RESULTS
558 women were studied (279 per group). The PO group had less gestational gain following recurrent preterm labor than the SQ group (28.4 +/- 19.8 days vs. 33.9 +/- 19.0 days, respectively, P < .001). The SQ group had less per patient charges ($) for antepartum hospitalization (3,986 +/- 6,895 vs. 5,495 +/- 7,131, P = .009), and nursery (7,143 +/- 20,048 vs. 15,050 +/- 32,648, P < .001). Outpatient charges were less for the PO group (1,390 +/- 1,152 vs. 5,520 +/- 3,292, P < .001). Overall costs for those in the SQ group were $5,286 less per pregnancy compared to the PO group.


CONCLUSIONS
In this population, continuous subcutaneous terbutaline infusion was both a clinically beneficial and cost-effective treatment following recurrent preterm labor.
Lam
Fung
F
California-Pacific Medical Center, 3838 California Street, San Francisco, Calif. 94118, USA.
Istwan
Niki B
NB
Jacques
Debbie
D
Coleman
Suzanne K
SK
Stanziano
Gary J
GJ
D000284:Administration, Oral; D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007279:Injections, Subcutaneous; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D018743:Perinatal Care / Q000191:economics / Q000379:methods*; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D013726:Terbutaline / Q000008:administration & dosage* / Q000627:therapeutic use; D015149:Tocolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D015149:Tocolytic Agents; D013726:Terbutaline