Antenatal healthcare service utilisation and associated costs in the TOBOGM randomized controlled trial – preliminary findings — ASN Events
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  2. Session 7: TOBOGM Seminar
  3. Antenatal healthcare service utilisation and associated costs in the TOBOGM randomized controlled trial – preliminary findings

Antenatal healthcare service utilisation and associated costs in the TOBOGM randomized controlled trial – preliminary findings (#35)

Mohammad Monirul Haque 1 , Kathy Tannous 2 , Jincy Immanuel 3 , William Hague 4 , Helena Teede 5 , N Wah Cheung 6 , Emily Hibbert 7 , Christopher Nolan 8 , Michael Peek 9 , Vincent Wong 10 , Jeff Flack 11 , Mark Mclean 12 , Arianne Sweeting 13 , Alexandra Kautzky-Willer 14 , Jürgen Harreiter 14 , Emily Gianatti 15 , Mohan V 16 , Helena Backman 17 , David Simmons 3
  1. Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
  2. School of Business, Western Sydney University, Parramatta, NSW, Australia
  3. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
  4. Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
  5. Monash Health , Monash University, Melbourne, VIC, Australia
  6. Westmead Hospital, Westmead, NSW, Australia
  7. Nepean Clinical School, University of Sydney and Nepean Hospital, Nepean, NSW, Australia
  8. Australian National University and Canberra Hospital, Canberra, ACT, Australia
  9. Australian National University, Canberra, ACT, Australia
  10. Liverpool Hospital, Liverpool, NSW, Australia
  11. Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  12. Blacktown Hospital, Blacktown, NSW, Australia
  13. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  14. Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
  15. Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA, Australia
  16. Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
  17. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Orevro University, Orevro, Sweden

Background: The Treatment Of Booking Gestational diabetes Mellitus (TOBOGM), an international multicentre randomised controlled trial (RCT), demonstrated that treatment of early gestational diabetes mellitus (GDM) improves maternal and neonatal outcomes. This study compared antenatal healthcare service utilisation and associated costs between intervention (immediate GDM treatment) and control (GDM treatment based on 24-28 week oral glucose tolerance test) participants in the trial.

Methods: Pregnant women with known risk factors for GDM enrolled in the TOBOGM RCT (https://www.nejm.org/doi/10.1056/NEJMoa2214956) were included.  Health services included (general practitioner, midwife, obstetrician, endocrinologist, dietitian, diabetes educator, emergency department, other medical/paramedic, ultrasound and blood test). Utilisation data were collected from participants’ self-reported questionnaires administered at 24-28- and 35-37-weeks’ gestation and hospital administrative records. The average number of times health services accessed was reported along with standard deviations and 95% confidence intervals. This number was multiplied by its respective unit cost to calculate cost. Unit cost prices were sourced from Medicare Benefits Schedule (MBS) and National Hospital Cost Data Collection (NHCDC). Costs were reported in 2022-23 Australian dollars ($A). Two-sample t-test was conducted to report the differences in health service utilisation between the control and intervention group.

Results: Intervention (n=406) (vs control, n=396) participants had more visits to midwives between <20 weeks and 24-28 weeks (+0.39, cost difference A$18.62, p=0.01), but less visits between 35-37 weeks and birth (-0.86, cost difference A$41.28, p=0.003); more visits to the obstetrician between 24-28 and 35-37 weeks (+0.46, cost difference A$17.05, p=0.04), and between 35-37 weeks and birth (+1.01, cost difference A$37.81, p<0.000);  a higher number of visits to endocrinologists (+0.63, cost difference A$43.41, p=0.03); more consultation with diabetes educator between 24-28 and 35-37 weeks (+0.63, cost difference A$11.28, p=0.004), and between 35-37 weeks and birth (+1.91, cost difference A$34.20, p<0.000); more ultrasound use between <20 and 24-28 weeks (+0.28, cost difference A$28.48, p=0.001). There was no significant difference between groups in the remaining health professional and healthcare service utilization.

Conclusion: Most antenatal healthcare utilization and costs were greater with early GDM treatment. Further work is needed to relate this to costs at and after birth and quality of life.

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