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

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Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries. / Taylor, Celia; Joolay, Yaseen; Buckle, Abigail; Lilford, Richard.

In: Maternal and Child Nutrition, Vol. 14 Suppl 6, 12.2018, p. e12595.

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@article{45321c809ce9434d8e28f183f98dd194,
title = "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.",
keywords = "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",
author = "Celia Taylor and Yaseen Joolay and Abigail Buckle and Richard Lilford",
note = "{\textcopyright} 2018 John Wiley & Sons Ltd.",
year = "2018",
month = dec,
doi = "10.1111/mcn.12595",
language = "English",
volume = "14 Suppl 6",
pages = "e12595",
journal = "Maternal and Child Nutrition",
issn = "1740-8695",
publisher = "Wiley",

}

RIS

TY - JOUR

T1 - Prioritising allocation of donor human breast milk amongst very low birthweight infants in middle-income countries

AU - Taylor, Celia

AU - Joolay, Yaseen

AU - Buckle, Abigail

AU - Lilford, Richard

N1 - © 2018 John Wiley & Sons Ltd.

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

KW - Birth Weight

KW - Costs and Cost Analysis

KW - Enterocolitis, Necrotizing/economics

KW - Female

KW - Humans

KW - Income

KW - Infant

KW - Infant Formula

KW - Infant, Newborn

KW - Infant, Premature

KW - Infant, Very Low Birth Weight/physiology

KW - Milk Banks

KW - Milk, Human

KW - Resource Allocation/economics

KW - South Africa

KW - Tissue Donors

KW - Tissue and Organ Procurement

U2 - 10.1111/mcn.12595

DO - 10.1111/mcn.12595

M3 - Article

C2 - 30592164

VL - 14 Suppl 6

SP - e12595

JO - Maternal and Child Nutrition

JF - Maternal and Child Nutrition

SN - 1740-8695

ER -