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.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.