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Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 2

(492) Cost Analysis of Permissive Intrapartum Glucose Control for Diabetes: the PERMIT Randomized Controlled Trial

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: In PERMIT randomized controlled trial (RCT), permissive intrapartum glucose control led to reduced need for maternal insulin drip and equivalent neonatal blood glucose when compared to usual care for patients with diabetes (Bitar, AJOG 2024). We aimed to evaluate its economic impact.

Study Design: This is a pre-planned cost analysis of a multisite RCT of permissive intrapartum glucose control (target maternal blood glucose 70–180mg/dL) or usual care (70–110 mg/dL) in patients with diabetes. Costs were assessed from the hospital perspective and included the facility costs for all the inpatient services provided to all enrolled parturients and their neonates during the delivery and birth admissions, respectively, as recorded in the cost-accounting system of the participating sites. Costs were inflated to 2024 based on the medical Consumer Price Index. We assessed differences in total combined maternal and neonatal costs (primary economic outcome), as well as individual maternal and neonatal costs, using frequentist generalized linear models (GLMs). We assessed the probability of reduction in costs using a Bayesian GLM model with a neutral prior assuming no benefit (rate ratio [RR]=1.0; 95% credible interval, 0.3–3.3). All frequentist and Bayesian models used gamma distribution with log link and adjusted for the stratifying variables (site and type of diabetes).

Results: Costs were determined for all 96 maternal-infant pairs. In intent-to-treat analysis, the total maternal and neonatal costs for permissive care were similar to those of usual care ($20,135 vs. $20,654; RR=1.00 [95% CI, 0.77–1.30], p=0.99; 49% probability of reduction).  Costs between permissive care and usual care were similar for both the parturients ($13,480 vs. $14,119; RR=0.96 (0.78–1.18), p=0.70; 69% probability of reduction) and the neonates ($6,655 vs. $6,535; 1.04 (0.63–1.73), p=0.87; 41% probability of reduction).

Conclusion: Permissive care is clinically equivalent and cost-neutral for both total maternal-neonatal costs and individual costs. These findings require validation in additional sites.