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Relative cost-effectiveness of using a liquid human milk fortifier in preterm infants in the US

Authors Guest JF, Moya F, Sisk PM, Hudak ML, Kuehn D

Received 15 September 2016

Accepted for publication 2 November 2016

Published 4 January 2017 Volume 2017:9 Pages 49—57


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Julian F Guest,1,2 Fernando Moya,3 Paula M Sisk,4 Mark L Hudak,5 Devon Kuehn6

1Catalyst Health Economics Consultants, Northwood, Middlesex, UK; 2Faculty of Life Sciences and Medicine, King’s College, London, UK; 3Coastal Carolina Neonatology, Wilmington, NC, USA; 4Novant Health Forsyth Medical Center, Winston Salem, NC, USA; 5Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA; 6Department of Pediatrics, East Carolina University, Greenville, NC, USA

Objective: To estimate the cost-effectiveness of using a liquid human milk fortifier (LHMF) compared to a powdered human milk fortifier (PHMF) in preterm infants in the US from the perspective of third-party payers and parents.
Methods: This was a decision modelling study using patient data obtained from a randomized controlled trial comparing a LHMF with a PHMF in preterm infants, supplemented with additional data obtained by performing a chart review among 79% of the trial patients. The model estimated the cost-effectiveness of LHMF versus PHMF in US$ at 2014/2015 prices.
Results: More infants in the LHMF group were discharged home (92% versus 89%) and more infants in the PHMF group were transferred to another unit (9% versus 5%). Gestational age was an independent predictor for being discharged home (odds ratio of 2.18; p=0.006 for each week of gestational age). Mean length of neonatal intensive care unit (NICU) stay was 1 day less in the LHMF than the PHMF group (62.3 versus 63.4 days), but mean length of NICU stay among infants who developed NEC or sepsis was 79.3 days and 61.2 days in the PHMF and LHMF groups, respectively. Total management cost up to discharge was $10,497 per infant less in the LHMF group than the PHMF group ($240,928 versus $251,425).
Conclusion: Using LHMF instead of PHMF in preterm infants enabled resources to be freed-up for alternative use within the system. There is no health economic reason why LHMF should not be used in preference to PHMF in the NICU.

Keywords: cost-effectiveness, milk fortifiers, neonatal intensive care, preterm infants, US

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