A systematic review of economic evaluations for donor human milk versus standard feeding in infants

Abstract

Reviews on the cost/outcome of donor human milk (DHM) for infants requiring care in the neonatal intensive care unit (NICU) setting have been undertaken. However, the cost-effectiveness evidence is unclear. Therefore, we conducted a systematic review of published full economic evaluations of DHM versus standard feeding in infants in neonatal care with the aim of undertaking a narrative synthesis of the costeffectiveness evidence and critical appraisal of the methods used. MEDLINE, EMBASE, Web of Science, Cochrane Library, Centre for Reviews and Dissemination (CRD) and PROSPERO databases were searched. Studies were included if they were full economic evaluations (model-based or trial-based), the participants were infants in neonatal units requiring nutritional support, the intervention was DHM and the comparator was any standard feeding option. There were no restrictions on outcome measures. Two authors independently assessed eligibility, extracted data, assessed quality and cross-checked results, with disagreements resolved by consensus. Information extracted focused on study context, and economic evaluation methods and results. Of 2861 studies, seven were included. Six (86%) studies originated from high-income countries. Four (57%) of the studies were model-based. Although we could not directly compare the different studies, due to the heterogenous nature of health and economic parameters used in the studies, all DHM interventions indicated cost-effective or cost saving results. This review suggests that economic evaluation of DHM interventions is an expanding area of research. Although these interventions show promise, future economic evaluations of DHM interventions need to explicitly provide more details on long-term costs and consequences.

Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study

“…Notably receiving DHM allowed parents to meet their feeding goals regarding their baby having human milk, and this was reported to have a significant protective impact upon maternal mental health in particular. Building upon existing evidence of the significant cost savings of providing human milk to premature infants [ 11 ], our findings highlight that extending DHM provision could play a.…”

“…Donor human milk (DHM) reduces the incidence of NEC [ 5 – 7 ], sepsis [ 8 ], and bronchopulmonary dysplasia [ 9 ]. Infants fed with DHM rather than infant formula where there is a shortfall of maternal milk also tolerate full feeds more rapidly and leave hospital sooner [ 10 ], with likely consequent cost-effectiveness in the hospital setting [ 11 ]. While research has typically focused on the health impacts in infants receiving DHM [ 12 ] or DHM content and variability [ 13 ], increasing data from international sources shows a beneficial effect on maternal breastfeeding rates when DHM is available in the context of optimal lactation support [ 14 – 16 ].…”

Receiving Screened Donor Human Milk for Their Infant Supports Parental Wellbeing: a Mixed-methods Study

“…Notably receiving DHM allowed parents to meet their feeding goals regarding their baby having human milk, and this was reported to have a signi cant protective impact upon maternal mental health in particular. Building upon existing evidence of the signi cant cost savings of providing human milk to premature infants, 11 our ndings highlight that extending DHM provision could play a potential preventative role in the signi cant health burden and cost implications of postnatal mental health issues 23 .…”

“…Donor human milk (DHM) reduces the incidence of NEC [5][6][7] , sepsis, 8 and bronchopulmonary dysplasia 9 . Infants fed with DHM rather than infant formula where there is a shortfall of maternal milk also tolerate full feeds more rapidly and leave hospital sooner 10 , with likely consequent costeffectiveness in the hospital setting 11 . While research has typically focused on the health impacts in infants receiving DHM 12 or DHM content and variability 13 , increasing data from international sources shows a bene cial effect on maternal breastfeeding rates when DHM is available in the context of optimal lactation support [14][15][16] .…”

25 Years of Research in Human Lactation: From Discovery to Translation

“…In past decades there has been a resurgence in the establishment of donor milk banks in an effort to provide HM for vulnerable infants [ 285 ]. Donor milk has been shown to have positive effects of infant mortality and morbidity [ 286 ] whilst being economically cost effective [ 287 ]. We have been active in the formulation of best practice in milk banking which varies according to geography and resources [ 288 ] as well as investigating pasteurization methods.…”