Cost-Effectiveness of a Comprehensive Team-Based Intervention for Pregnant Women with Diabetes: A Markov Cohort Study

Speaker(s)

Gupta D1, Frongillo EA2, Self S2, Litwin A3, Schellinger M4, Fiocchi C5, Stancil MD5, Cart C4, Rudisill C2
1Arnold School of Public Health, University of South Carolina, West Columbia, SC, USA, 2Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 3Addiction Medicine Center, Prisma Health, Greenville, SC, USA, 4Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC, USA, 5Diabetes Self-Management Education and Support, Prisma Health, Greenville, SC, USA

Presentation Documents

OBJECTIVES: Diabetes rates during pregnancy have surged in the US over the last decade with social determinants of health (SDOH) such as food insecurity, transportation deficits, and rural residency exacerbating maternal hospitalizations and care costs. This study examines the cost-effectiveness of a comprehensive program addressing SDOH-related needs of pregnant women with diabetes (‘Management of Maternal Diabetes (MOMs) in Control of Diabetes in Pregnancy’) in South Carolina’s largest health system. MOMs involves a multidisciplinary healthcare team at a single location, rural telehealth, food support (via produce boxes, on-site pantry), and outpatient insulin initiation (vs. usual practice requiring hospitalization). By addressing SDOH needs and providing outpatient insulin initiation, MOMs aims to reduce maternal hospitalizations and costs.

METHODS: Using a payer perspective and a Markov cohort model, the study evaluates the incremental cost per hospitalization averted during pregnancy by MOMs participants versus those receiving standard care. Qualifying patients include pregnant women with Type 1, Type 2 or gestational diabetes requiring insulin or other diabetes medications with deliveries from June 1, 2020 – March 31, 2023. Costs for MOMs participants (healthcare and program costs) and hospitalization data come from electronic medical records and program data. The standard care group is modeled using literature-derived hospitalization rates and MOMs healthcare cost estimates.

RESULTS: MOMs patients (n=483) had mean age of 30.3 ± 6.3 years, Medicaid/Medicare (262, 57.6%) as primary payers or were uninsured (150, 31.1%). Of these patients, 187 (38.7%) were White and 126 (26.1%) African American while 191 (39.5%) reported Hispanic ethnicity. Operational costs and cost-effectiveness of the MOMs program expressed as cost per hospitalization averted will be presented.

CONCLUSIONS: This is the first cost-effectiveness study of an SDOH-related program for pregnant women with diabetes and offers valuable insights to health systems and payers on sustainability of such initiatives. Cost-related findings may have policy implications within South Carolina’s Medicaid.

Code

EE441

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas