17alpha-hydroxyprogesterone caproate for the prevention of preterm delivery: A cost-effectiveness analysis.
OBJECTIVE
To evaluate whether the use of 17alpha-hydroxyprogesterone caproate for the prevention of recurrent preterm deliveries is cost-effective.


METHODS
Using decision-analysis modeling, we compared the cost-effectiveness of using 17alpha-hydroxyprogesterone caproate in four subgroups: 1) Prior preterm deliveries less than 32 weeks; 2) prior preterm deliveries 32-37 weeks; 3) prior term delivery; and 4) no prior delivery. Each subgroup was compared with a "no treatment" group. Costs included those for 17alpha-hydroxyprogesterone caproate, hospital admissions, and complications from preterm deliveries. The main outcome measures include cost per quality-adjusted life-year gained and the number of preterm deliveries prevented. Secondary outcomes include neonatal complications prevented. One-way and multiway sensitivity analyses were performed.


RESULTS
The use of 17alpha-hydroxyprogesterone caproate for the prevention of preterm deliveries result in cost-savings in women with prior preterm deliveries less than 32 weeks and 32-37 weeks. The sensitivity analyses revealed the model to be robust over a wide range of values for evaluated variables.


CONCLUSIONS
Within our baseline assumptions, 17alpha-hydroxyprogesterone caproate was associated with cost-savings when used for the prevention of preterm deliveries in women with prior preterm deliveries.
Odibo
Anthony O
AO
Department of Obstetrics and Gynecology, Center for Clinical Epidemiology and Biostatistics, Internal Medicine and Health Management Systems, Washington University Medical Center in St. Louis, Missouri 63110, USA. odiboa@wudosis.wustl.edu
Stamilio
David M
DM
Macones
George A
GA
Polsky
Daniel
D
D000077713:17 alpha-Hydroxyprogesterone Caproate; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006908:Hydroxyprogesterones / Q000191:economics* / Q000627:therapeutic use*; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D007752:Obstetric Labor, Premature / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D010298:Parity; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011372:Progestins / Q000191:economics* / Q000627:therapeutic use*; D012307:Risk Factors; D055502:Secondary Prevention; D014481:United States
D006908:Hydroxyprogesterones; D011372:Progestins; D000077713:17 alpha-Hydroxyprogesterone Caproate