Pharmacoeconomic impact of use of the probiotic Lactobacillus reuteri DSM 17938 for prevention of necrotizing enterocolitis in extremely low-birth-weight infants

Mary Ann VT Dimaguila,^1,2 Peter Gal,^1,3,4 Tiffany Wilson,¹ John E Wimmer Jr,^1,2 McCrae Smith,^1,2 Rita Q Carlos,^1,2 Christie C Davanzo,^1,2 J Laurence Ransom<sup>1,2

1</sup>Women's Hospital of Greensboro, Cone Health, Greensboro, NC, USA; ²Piedmont Neonatology, Greensboro, NC, USA; ³Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ⁴Greensboro Area Health Education Center, Greensboro, NC, USA

Background: A recent study showed that use of Lactobacillus reuteri as probiotic prophylaxis decreased the necrotizing enterocolitis (NEC) rate from 15.1% to 2.5% in neonates with birth weight below 1000 g. Given the controversies surrounding use of probiotics in neonatal intensive care units, we address one additional aspect of routine implementation of probiotics for NEC prophylaxis – the pharmacoeconomic impact.
Methods: Using data from our initial published experience, and continuing data collection after instituting a higher dose of L. reuteri, we measured the reduction in NEC in neonates with birth weight below 1000 g. Cost savings from prior studies examining the cost and outcomes of medical and surgical NEC were used to calculate the financial impact of routine L. reuteri DSM 17938 prophylaxis.
Results: Medical records for 354 neonates were reviewed, 232 in the years before introduction of L. reuteri prophylaxis and 79 who received L. reuteri prophylaxis dosed at 0.1 mL daily and 43 neonates given a total daily dose of 0.2 mL as one or two doses. The incidence of NEC was significantly lower in the neonates who received L. reuteri (two of 122 neonates [1.6%] versus 35 of 232 neonates [15.1%]). The expected benefits for our neonatal intensive care unit per 100 extremely low-birth-weight neonates treated were four fewer deaths, five fewer cases of medical NEC, eight fewer cases of surgical NEC, one less patient with short-bowel syndrome, and a cost saving of approximately $2.2 million.
Conclusion: Prophylactic initiation of L. reuteri as a probiotic for prevention of NEC in neonates with birth weight ≤ 1000 g is a cost-effective strategy during their stay in neonatal intensive care.

Keywords: necrotizing enterocolitis, probiotic, extremely low birth weight, Lactobacillus reuteri, pharmacoeconomics