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Published on: July 19, 2014
Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)
Warda Tahir1, Mark Monahan1, Jon Dorling2
1University of Birmingham, Birmingham, UK.
Insights
Advancing enteral feeds faster in very preterm infants did not improve survival outcomes and may be harmful. This randomized controlled trial found slower feed advancement to be safer for very low birth weight infants.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Health Economics
Background:
- Optimizing enteral nutrition is crucial for the growth and development of very preterm and very low birth weight infants.
- The optimal rate of enteral feed advancement in this vulnerable population remains a subject of clinical debate.
- Previous studies have suggested potential benefits of faster feed advancement, but cost-effectiveness data are limited.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of two different rates of enteral feed advancement (18 mL/kg/day vs. 30 mL/kg/day) in very preterm and very low birth weight infants.
- To evaluate the primary outcome of survival without moderate to severe neurodevelopmental disability at 24 months corrected age.
Main Methods:
- A multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial) was conducted.
- Infants born before 32 weeks' gestation or weighing less than 1500 g were randomized to receive daily feed increments of 18 mL/kg/day (control) or 30 mL/kg/day (intervention).
- A within-trial economic evaluation was performed, assessing costs per additional survivor without moderate to severe neurodevelopmental disability at 24 months corrected age.
Main Results:
- Average costs per infant were marginally higher in the faster feeds arm (£267 difference), though not statistically significant.
- Fewer infants in the faster feeds arm achieved the primary outcome of survival without moderate to severe neurodevelopmental disability at 24 months (802/1224 vs. 848/1246).
- Stochastic cost-effectiveness analysis indicated a higher likelihood of worse outcomes with faster feed advancement.
Conclusions:
- Faster enteral feed advancement (30 mL/kg/day) is not cost-effective for improving survival without neurodevelopmental disability in very preterm infants.
- The faster rate of feed advancement was associated with poorer neurodevelopmental outcomes at 24 months corrected age.
- Slower enteral feed advancement (18 mL/kg/day) is recommended on both cost and effectiveness grounds for this population.
Objective:
To evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants.
Design:
Within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial).
Setting:
55 UK neonatal units from May 2013 to June 2015.
Patients:
Infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible.
Interventions:
When clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control).
Main Outcome Measure:
Cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity.
Results:
Average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds.
Conclusions:
The stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome.
