Managing Perinatal Outcomes: The Clinical Benefit and Cost-Effectiveness of Pharmacologic Treatment of Recurrent Preterm Labor

Continuous subcutaneous terbutaline infusion shows improved clinical outcomes and decreased nursery costs compared with oral tocolytics in women with recurrent preterm labor.

Fung Lam, MD
California-Pacific Medical Center, San Francisco, Calif.
Niki B. Istwan, RN, BS
Matria Healthcare Dept. of Clinical Research, Marietta, Ga.
Debbie Jacques, MPH
Matria Healthcare Dept. of Clinical Research, Marietta, Ga.
Suzanne K. Coleman, RNC, MS
Matria Healthcare Dept. of Clinical Research, Marietta, Ga.
Gary J. Stanziano, MD
Matria Healthcare Dept. of Clinical Research, Marietta, Ga.

ABSTRACT

Purpose: To compare the clinical benefit and cost-effectiveness of utilizing continuous subcutaneous terbutaline versus oral tocolytics following recurrent preterm labor.

Design: Retrospective, 1:1 matched cohort.

Methodology: 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.

Principal findings: 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.

Conclusion: In this population, continuous subcutaneous terbutaline infusion was both a clinically beneficial and cost-effective treatment following recurrent preterm labor.

Key terms: Health economics, pregnancy, preterm labor, tocolysis, terbutaline, cost-effectiveness, outcomes.

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