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Unjustified Increase in Cost of Care Resulting From U.S. Food and Drug Administration Approval of Makena (17a-Hydroxyprogesterone Caproate)

Cohen, Arnold W. MD; Copel, Joshua A. MD; Macones, George A. MD; Menard, M. Kathryn MD, MPH; Riley, Laura MD; Saade, George R. MD

doi: 10.1097/AOG.0b013e31821c2d75
Current Commentary

U.S. Food and Drug Administration (FDA) approval of 17α-hydroxyprogesterone caproate for the indication of decreasing the risk of preterm delivery in those high-risk patients who previously had spontaneous preterm birth has come at considerable cost to the health care system. Weekly injections provided by compounding pharmacies starting at 16–20 weeks of gestation and continuing until 36 weeks currently cost the health care system $200 to $300 per pregnancy. This cost is significantly less than the costs associated with delivering and caring for preterm children. Makena, by KV Pharmaceutical, the same 17α-hydroxyprogesterone caproate product, is priced at $1,500 per injection, or a projected cost of $30,000 per pregnancy. With approximately 132,000 pregnancies being eligible for treatment annually, this increase in cost of 75–150 times what previously had been paid far exceeds the benefits derived from the FDA-approved Makena when compared with previously available compounded versions of 17α-hydroxyprogesterone caproate. This increased health care cost is not justified at this time. The price barrier to access imposed by KV Pharmaceutical actually could result in an increase in preterm deliveries over current rates. Actions are needed by the FDA, national societies, and the manufacturer to ensure that all high-risk patients continue to get the needed therapy to reduce the number of preterm births.

Access to treatment with 17α-hydroxyprogesterone caproate to reduce risk of preterm birth is at risk of becoming significantly limited by the extremely high proposed price of the U.S. Food and Drug Administration-approved product Makena.

From the Albert Einstein Medical Center, Philadelphia, Pennsylvania; the Yale University School of Medicine, New Haven, Connecticut; the Washington University School of Medicine, St. Louis, Missouri; the University of North Carolina School of Medicine, Chapel Hill, North Carolina; Massachusetts General Hospital, Boston, Massachusetts; and the University of Texas Medical Branch, Galveston, Texas.

See related editorial on page 1263.

Corresponding author: M. Kathryn Menard, MD, MPH, CB# 7516, 3010 Old Clinic Bldg., Chapel Hill, NC 27599-7516, 919-966-1601; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.