Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle‐income countries

Abstract

The use of donor human breast milk instead of formula reduces the risk of necrotising enterocolitis in preterm infants when their mother's own milk is insufficient. Use of donor milk is limited by the cost of establishing a milk bank and a lack of donors, but the optimal rationing of limited donor milk is unclear. This paper uses an economic model to explore how a limited donor milk supply should be allocated across very low birthweight infants in South Africa considering 2 outcomes: maximising lives saved and minimising costs. We developed a probabilistic cohort Markov decision model with 10,000 infants across 4 birthweight groups. We evaluated allocation scenarios in which infants in each group could be exclusively formula‐fed or fed donor milk for 14 or 28 days and thereafter formula until death or discharge. Prioritising infants in the lowest birthweight groups would save the most lives, whereas prioritising infants in the highest birthweight groups would result in the highest cost savings. All allocation scenarios would be considered very cost‐effective in South Africa compared to the use of formula; the “worst case” was $619 per Disability Adjusted Life Year averted. There is a compelling argument to increase the supply of donor milk in middle‐income countries. Our analysis could be extended by taking a longer term perspective, using data from more than one country and exploring the use of donor milk as an adjunct to mother's own milk, rather than a pure substitute for it.

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

“…The data that support the findings of this study are available in the article text, tables, figure and references in the tables (Arnold, 2002;Assad et al, 2016;Dritsakou et al, 2016;Ganapathy et al, 2012;Hampson et al, 2019;Taylor et al, 2018;Trang et al, 2018) and supporting information.…”

“…The majority of the studies reported clinical outcome measures (e.g., incidence of NEC). Only one of the seven studies (Taylor et al, 2018) reported health-related outcome measures (e.g., DALY) commonly used within economic evaluations. None of the included studies explicitly reported that they were CBA.…”

“…All studies reported their currency. For the study by Taylor et al (2018) costs were converted to 2015 US Dollars at Purchasing Power Parity (PPP) using the World Bank exchange rates.…”

“…Only two (29%) studies stated the costs which were excluded from their costing. These were discharges with an average daily cost of <$100 and infants who died within the first 3 days of life for the study by Ganapathy et al (2012) and costs to parents and society and long-term health service costs by Taylor et al (2018).…”

“…However, cost savings of their analysis suggests that it is worth investigating the likelihood that an EHMD is cost-effective in other settings. Data from the study by Taylor et al (2018) was based on clinical data provided by one hospital, and there might be differences between hospitals even within a single country. The authors mentioned that although published data for some parameters exist for high income countries, mostly the US, these data cannot be applied to many middle-income settings because of the lack of specialist neonatal equipment.…”