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

Celia Taylor, Yaseen Joolay, Abigail Buckle, Richard Lilford

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)e12595
JournalMaternal and Child Nutrition
Volume14 Suppl 6
Publication statusPublished - Dec 2018

Bibliographical note

© 2018 John Wiley & Sons Ltd.


  • Birth Weight
  • Costs and Cost Analysis
  • Enterocolitis, Necrotizing/economics
  • Female
  • Humans
  • Income
  • Infant
  • Infant Formula
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight/physiology
  • Milk Banks
  • Milk, Human
  • Resource Allocation/economics
  • South Africa
  • Tissue Donors
  • Tissue and Organ Procurement


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