Susan Trang1,2, John A F Zupancic3, Sharon Unger4,5, Alex Kiss6,7, Nicole Bando2, Sabrina Wong8, Sharyn Gibbins9, Deborah L O'Connor10,2,5. 1. Departments of Nutritional Sciences. 2. Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada. 3. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Paediatrics, and. 5. Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. 7. Evaluative Clinical Sciences and. 8. Neonatology, Sunnybrook Health Sciences Centre, Toronto, Canada; and. 9. Professional Practice, Trillium Health Partners, Mississauga, Canada. 10. Departments of Nutritional Sciences, deborah.oconnor@utoronto.ca.
Abstract
OBJECTIVES: To determine the cost-effectiveness of supplemental donor human milk (DHM) versus preterm formula (PTF) for very low birth weight (VLBW, <1500 g) infants from a societal perspective to 18 months' corrected age. METHODS: This prospective cost-effectiveness analysis of 363 VLBW infants was conducted for a randomized control trial. Infants recruited from October 2010 to December 2012 were fedDHM or PTF whenever mother's milk was unavailable. Formal health care costs for initial hospitalization and readmissions were obtained from standardized cost-accounting systems and physician fees. Informal and nonhealth care sector costs (eg, caregiver transportation, labor market earnings) were calculated from parent reports. RESULTS:Mean infant birth weight was 996 (SD, 272) grams. Incidence of necrotizing enterocolitis (NEC) differed between groups (all stages 3.9% DHM, 11.0% PTF; P = .01). Costs to 18 months did not differ with a mean (95% confidence interval) of 217 624 (197 697-237 551) and 217 245 (196 494-237 995) 2015 Canadian dollars in the DHM and PTF groups. Postdischarge costs were lower in the DHM (46 440 [40 648-52 233]) than PTF group (55 102 [48 269-61 934]) (P = .04), driven by parent lost wages. DHM cost an additional $5328 per case of averted NEC. CONCLUSIONS: In a high mother's milk use setting, total costs from a societal perspective to 18 months of providing supplemental DHM versus PTF to VLBW infants did not differ, although postdischarge costs were lower in the DHM group. Although supplemental DHM was not cost-saving, it reduced NEC supporting its use over PTF.
RCT Entities:
OBJECTIVES: To determine the cost-effectiveness of supplemental donorhuman milk (DHM) versus preterm formula (PTF) for very low birth weight (VLBW, <1500 g) infants from a societal perspective to 18 months' corrected age. METHODS: This prospective cost-effectiveness analysis of 363 VLBW infants was conducted for a randomized control trial. Infants recruited from October 2010 to December 2012 were fed DHM or PTF whenever mother's milk was unavailable. Formal health care costs for initial hospitalization and readmissions were obtained from standardized cost-accounting systems and physician fees. Informal and nonhealth care sector costs (eg, caregiver transportation, labor market earnings) were calculated from parent reports. RESULTS: Mean infant birth weight was 996 (SD, 272) grams. Incidence of necrotizing enterocolitis (NEC) differed between groups (all stages 3.9% DHM, 11.0% PTF; P = .01). Costs to 18 months did not differ with a mean (95% confidence interval) of 217 624 (197 697-237 551) and 217 245 (196 494-237 995) 2015 Canadian dollars in the DHM and PTF groups. Postdischarge costs were lower in the DHM (46 440 [40 648-52 233]) than PTF group (55 102 [48 269-61 934]) (P = .04), driven by parent lost wages. DHM cost an additional $5328 per case of averted NEC. CONCLUSIONS: In a high mother's milk use setting, total costs from a societal perspective to 18 months of providing supplemental DHM versus PTF to VLBW infants did not differ, although postdischarge costs were lower in the DHM group. Although supplemental DHM was not cost-saving, it reduced NEC supporting its use over PTF.
Authors: Michelle R Asbury; Sharon Unger; Alex Kiss; Dawn V Y Ng; Yunnie Luk; Nicole Bando; Rosine Bishara; Christopher Tomlinson; Deborah L O'Connor Journal: Am J Clin Nutr Date: 2019-12-01 Impact factor: 7.045
Authors: Laura R Kair; Nichole L Nidey; Jessie E Marks; Kirsten Hanrahan; Lorraine Femino; Erik Fernandez Y Garcia; Kelli Ryckman; Kelly E Wood Journal: J Hum Lact Date: 2019-11-26 Impact factor: 2.219
Authors: Katie M Strobel; Tahmineh Romero; Katelin Kramer; Erika Fernandez; Catherine Rottkamp; Cherry Uy; Roberta Keller; Laurel Moyer; Francis Poulain; Jae H Kim; Daniel A DeUgarte; Kara L Calkins Journal: J Pediatr Date: 2021-02-26 Impact factor: 6.314