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Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries
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Taylor, Celia A., Joolay, Yaseen, Buckle, Abigail and Lilford, Richard (2018) Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries. Maternal and Child Nutrition, 14 (S6). e12595. doi:10.1111/mcn.12595
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Official URL: https://doi.org/10.1111/mcn.12595
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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Breast milk -- Collection and preservation -- Cost effectiveness -- South Africa, Birth weight, Low | ||||||||
| Journal or Publication Title: | Maternal and Child Nutrition | ||||||||
| Publisher: | Wiley | ||||||||
| ISSN: | 1092-7875 | ||||||||
| Official Date: | December 2018 | ||||||||
| Dates: |
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| Volume: | 14 | ||||||||
| Number: | S6 | ||||||||
| Article Number: | e12595 | ||||||||
| DOI: | 10.1111/mcn.12595 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Publisher Statement: | "This is the peer reviewed version of the following article: Taylor C, Joolay Y, Buckle A, Lilford R. Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle‐income countries. Matern Child Nutr. 2018;14(S6):e12595. https://doi.org/10.1111/mcn.12595 which has been published in final form at https://doi.org/10.1111/mcn.12595 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| RIOXX Funder/Project Grant: |
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