Medication utilization in children born preterm in the first two years of life

Abstract

Objective: To compare medications dispensed during the first 2 years in children born preterm and full-term.

Study design: Retrospective analysis of claims data from a commercial national managed care plan 2008-2019. 329,855 beneficiaries were enrolled from birth through 2 years, of which 25,408 (7.7%) were preterm (<37 weeks). Filled prescription claims and paid amount over 2 years were identified.

Results: In preterm children, the number of filled prescriptions was 1.4 times and cost was 3.8 times that of full-term children. Number and cost of medications were inversely related to gestational age. Differences peak at 4-9 months and resolve by 19 months after discharge. Palivizumab, ranitidine, albuterol, lansoprazole, budesonide, and prednisolone had the greatest differences in utilization.

Conclusion: Prescription medication utilization among preterm children under 2 years is driven by palivizumab, anti-reflux, and respiratory medications, despite little evidence regarding efficacy for many medications and concern for harm with certain classes.

Figure 1.. Unique medications prescribed and costs by gestational since neonatal discharge

Medications and cost over time since newborn hospital discharge, stratified by Gestational Age. Costs were defined as the sum of amount paid by the insurer and member out of pocket costs.

Figure 2.. Duration of Supply among medications with greatest difference in prescribing frequency

Medications selected are those with the ten greatest risk difference between early preterm (≤32 weeks) and full-term population selected for visualization. Height of bars represent mean. Error bars represent standard error. * = p < 0.05, ** = p ≤ 0.01, *** = p ≤ 0.001 compared to full-term group by two-sided t test. GA = Gestational Age