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Obstetrics & Gynecology 2006;108:492-499
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

17{alpha}-hydroxyprogesterone Caproate for the Prevention of Preterm Delivery

A Cost-effectiveness Analysis

Anthony O. Odibo, MD, FRCOG1,3, David M. Stamilio, MD, MSCE2, George A. Macones, MD, MSCE1 and Daniel Polsky, PhD2,3

From the Departments of Obstetrics and Gynecology and Center for Clinical Epidemiology and Biostatistics, Internal Medicine and Health Management Systems, 1Washington University Medical Center in St. Louis, Missouri; 2University of Pennsylvania; and 3Leonard Davis Institute, Philadelphia, Pennsylvania.

OBJECTIVE: To evaluate whether the use of 17{alpha}-hydroxyprogesterone caproate for the prevention of recurrent preterm deliveries is cost-effective.

METHODS: Using decision-analysis modeling, we compared the cost-effectiveness of using 17{alpha}-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 17{alpha}-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 17{alpha}-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.

CONCLUSION: Within our baseline assumptions, 17{alpha}-hydroxyprogesterone caproate was associated with cost-savings when used for the prevention of preterm deliveries in women with prior preterm deliveries.

LEVEL OF EVIDENCE: II-3






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