• Sessions
• Presentations
• Posters
• Rooms

Presentation

Session: Early Childhood
Room: Helsinki Hall
Time: Sat 10:15-11:30

Presenter: Stephen Rice (Centre for Reviews and Dissemination. University of York)

Abstract

Background

There is evidence that breastmilk feeding reduces mortality and short and long-term morbidity among infants born too soon or too small. A Health Technology Assessment (HTA) examined the clinical effectiveness and cost-effectiveness of breastfeeding promotion interventions for mothers of infants in neonatal units. This paper reports the cost-effectiveness analysis part of the HTA, which evaluates the cost-effectiveness of enhanced staff contact for mothers with infants with a birth weight of 500-2500g. In the base case, it was assumed that formula milk only was provided as a supplement to mothers’ own milk.

Methods

A decision-tree model was developed to evaluate the cost-effectiveness of enhanced staff contact from the perspective of the NHS in the UK. The time horizon of the study was lifetime. The study population was mothers with infants in a neonatal unit with a birth weight of 500-2500g. This population was divided into three weight bands because of significant differences in baseline risk of disease between these bands. Clinical experts decided that the most important clinical events were medical and surgical necrotising enterocolitis (NEC), and fungal, Gram-positive and Gram-negative sepsis. An infant that experienced one of these events was at risk of long-term mild, moderate or severe neurodevelopmental impairment. These long-term health states were allocated utility values derived from the literature. The effectiveness of the enhanced staff contact on consumption of mothers’ own milk was obtained from the effectiveness review part of the HTA. Other clinical data were obtained from separate literature reviews. Cost data were obtained from published national sources. The measure of benefit was the Quality Adjusted Life Year. The outcome measure was the incremental cost-utility ratio of enhanced staff contact versus normal staff contact. Uncertainty was evaluated using cost-effectiveness acceptability curves and sensitivity analyses.

Results

In the base case analysis, enhanced staff contact was less costly and more effective than normal staff contact for each birth weight group. The lower the birth weight, the greater the cost-savings and the greater the QALY gain. This was because the incidence of NEC increased as the birth weight decreased. The results were quite robust to the sensitivity analyses performed. However, the sensitivity analyses do not fully evaluate the impact on the results of the limited evidence available or of the external validity for the UK of the evidence from different countries.

Discussion

This paper links three factors: a significant reduction in NEC due to consumption of breastmilk versus formula milk; an absence of significant adverse events from the consumption of breastmilk compared to formula milk; and a relatively cheap intervention compared to the cost savings associated with a reduced incidence of NEC. Taken together they suggest a cost-effective result.

This is the first economic evaluation in this complex field and offers a model to be developed in future research. The results provide preliminary indications that enhanced staff contact may be cost-effective. However, the limited evidence available, and the limited UK data in particular, suggest that further research is required to provide results with confidence.

Key Terms

Staff contact/breastmilk/cost-effectiveness

Authors:

Stephen Rice (University of York. Centre for Reviews and Dissemination) , Dawn Craig (University of York. Centre for Reviews and Dissemination) , Anthony Williams (University of London. St George's Hospital Medical School) , Felicia McCormick (University of York. Department of Health Sciences) and Mary Renfrew (University of York. Department of Health Sciences)

Search with Google