Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low Birth Weight Infants

Area of Science:

• Neonatal nutrition
• Health economics
• Pediatric outcomes

Background:

• Very low birth weight (VLBW) infants (<1500 g) often require nutritional support beyond mother's milk.
• Donor human milk (DHM) and preterm formula (PTF) are common alternatives, with varying cost-effectiveness implications.
• Understanding the societal perspective on costs is crucial for evidence-based clinical decisions.

Purpose of the Study:

• To compare the cost-effectiveness of supplemental DHM versus PTF for VLBW infants from a societal perspective up to 18 months corrected age.
• To analyze healthcare and non-healthcare sector costs associated with each feeding strategy.
• To evaluate the impact of feeding choices on infant outcomes like necrotizing enterocolitis (NEC).

Main Methods:

• Prospective cost-effectiveness analysis of 363 VLBW infants within a randomized control trial.
• Data collection on formal healthcare costs (hospitalization, readmissions) and informal costs (caregiver time, lost earnings).
• Follow-up to 18 months corrected age to capture total societal costs.

Main Results:

• Total costs to 18 months did not significantly differ between DHM and PTF groups (approx. $217,600 CAD).
• Incidence of necrotizing enterocolitis (NEC) was significantly lower in the DHM group (3.9%) compared to the PTF group (11.0%; P = .01).
• Post-discharge costs were lower in the DHM group, primarily driven by reduced parental lost wages (P = .04).

Conclusions:

• Supplemental DHM for VLBW infants is not cost-saving but reduces NEC incidence and lowers post-discharge societal costs.
• The findings support the use of DHM over PTF in settings with high mother's milk utilization, considering both clinical and economic factors.
• Further research could explore long-term neurodevelopmental outcomes and refine cost-benefit analyses.