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Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants.
Breastfeed Med. 2012 Feb; 7(1):29-37.BM

Abstract

OBJECTIVE

This study evaluated the cost-effectiveness of a 100% human milk-based diet composed of mother's milk fortified with a donor human milk-based human milk fortifier (HMF) versus mother's milk fortified with bovine milk-based HMF to initiate enteral nutrition among extremely premature infants in the neonatal intensive care unit (NICU).

METHODS

A net expected costs calculator was developed to compare the total NICU costs among extremely premature infants who were fed either a bovine milk-based HMF-fortified diet or a 100% human milk-based diet, based on the previously observed risks of overall necrotizing enterocolitis (NEC) and surgical NEC in a randomized controlled study that compared outcomes of these two feeding strategies among 207 very low birth weight infants. The average NICU costs for an extremely premature infant without NEC and the incremental costs due to medical and surgical NEC were derived from a separate analysis of hospital discharges in the state of California in 2007. The sensitivity of cost-effectiveness results to the risks and costs of NEC and to prices of milk supplements was studied.

RESULTS

The adjusted incremental costs of medical NEC and surgical NEC over and above the average costs incurred for extremely premature infants without NEC, in 2011 US$, were $74,004 (95% confidence interval, $47,051-$100,957) and $198,040 (95% confidence interval, $159,261-$236,819) per infant, respectively. Extremely premature infants fed with 100% human-milk based products had lower expected NICU length of stay and total expected costs of hospitalization, resulting in net direct savings of 3.9 NICU days and $8,167.17 (95% confidence interval, $4,405-$11,930) per extremely premature infant (p < 0.0001). Costs savings from the donor HMF strategy were sensitive to price and quantity of donor HMF, percentage reduction in risk of overall NEC and surgical NEC achieved, and incremental costs of surgical NEC.

CONCLUSIONS

Compared with feeding extremely premature infants with mother's milk fortified with bovine milk-based supplements, a 100% human milk-based diet that includes mother's milk fortified with donor human milk-based HMF may result in potential net savings on medical care resources by preventing NEC.

Authors+Show Affiliations

Department of Clinical Pharmacy & Pharmaceutical Economics & Policy, University of Southern California, Los Angeles, California 90089-7273, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21718117

Citation

Ganapathy, Vaidyanathan, et al. "Costs of Necrotizing Enterocolitis and Cost-effectiveness of Exclusively Human Milk-based Products in Feeding Extremely Premature Infants." Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, vol. 7, no. 1, 2012, pp. 29-37.
Ganapathy V, Hay JW, Kim JH. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeed Med. 2012;7(1):29-37.
Ganapathy, V., Hay, J. W., & Kim, J. H. (2012). Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, 7(1), 29-37. https://doi.org/10.1089/bfm.2011.0002
Ganapathy V, Hay JW, Kim JH. Costs of Necrotizing Enterocolitis and Cost-effectiveness of Exclusively Human Milk-based Products in Feeding Extremely Premature Infants. Breastfeed Med. 2012;7(1):29-37. PubMed PMID: 21718117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. AU - Ganapathy,Vaidyanathan, AU - Hay,Joel W, AU - Kim,Jae H, Y1 - 2011/06/30/ PY - 2011/7/2/entrez PY - 2011/7/2/pubmed PY - 2012/4/18/medline SP - 29 EP - 37 JF - Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine JO - Breastfeed Med VL - 7 IS - 1 N2 - OBJECTIVE: This study evaluated the cost-effectiveness of a 100% human milk-based diet composed of mother's milk fortified with a donor human milk-based human milk fortifier (HMF) versus mother's milk fortified with bovine milk-based HMF to initiate enteral nutrition among extremely premature infants in the neonatal intensive care unit (NICU). METHODS: A net expected costs calculator was developed to compare the total NICU costs among extremely premature infants who were fed either a bovine milk-based HMF-fortified diet or a 100% human milk-based diet, based on the previously observed risks of overall necrotizing enterocolitis (NEC) and surgical NEC in a randomized controlled study that compared outcomes of these two feeding strategies among 207 very low birth weight infants. The average NICU costs for an extremely premature infant without NEC and the incremental costs due to medical and surgical NEC were derived from a separate analysis of hospital discharges in the state of California in 2007. The sensitivity of cost-effectiveness results to the risks and costs of NEC and to prices of milk supplements was studied. RESULTS: The adjusted incremental costs of medical NEC and surgical NEC over and above the average costs incurred for extremely premature infants without NEC, in 2011 US$, were $74,004 (95% confidence interval, $47,051-$100,957) and $198,040 (95% confidence interval, $159,261-$236,819) per infant, respectively. Extremely premature infants fed with 100% human-milk based products had lower expected NICU length of stay and total expected costs of hospitalization, resulting in net direct savings of 3.9 NICU days and $8,167.17 (95% confidence interval, $4,405-$11,930) per extremely premature infant (p < 0.0001). Costs savings from the donor HMF strategy were sensitive to price and quantity of donor HMF, percentage reduction in risk of overall NEC and surgical NEC achieved, and incremental costs of surgical NEC. CONCLUSIONS: Compared with feeding extremely premature infants with mother's milk fortified with bovine milk-based supplements, a 100% human milk-based diet that includes mother's milk fortified with donor human milk-based HMF may result in potential net savings on medical care resources by preventing NEC. SN - 1556-8342 UR - https://www.unboundmedicine.com/medline/citation/21718117/Costs_of_necrotizing_enterocolitis_and_cost_effectiveness_of_exclusively_human_milk_based_products_in_feeding_extremely_premature_infants_ L2 - https://www.liebertpub.com/doi/10.1089/bfm.2011.0002?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -