Abstract
Human milk-based fortifiers have shown a protective effect on major complications for very low birth weight newborns. The current study aimed to estimate the cost-effectiveness of an exclusive human milk diet (EHMD) compared to the current approach using cow's milk-based fortifiers in very low birth weight newborns. A decision tree model using the health states of necrotising enterocolitis (NEC), sepsis, NEC + sepsis and no complication was used to calculate the cost-effectiveness of an EHMD. For each health state, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (RoP) and neurodevelopmental problems were included as possible complications; additionally, short-bowel syndrome (SBS) was included as a complication for surgical treatment of NEC. The model was stratified into birth weight categories. Costs for inpatient treatment and long-term consequences were considered from a third party payer perspective for the reference year 2017. Deterministic and probabilistic sensitivity analyses were performed, including a societal perspective, discounting rate and all input parameter-values. In the base case, the EHMD was estimated to be cost-effective compared to the current nutrition for very low birth weight newborns with an incremental cost-effectiveness ratio (ICER) of €28,325 per Life-Year-Gained (LYG). From a societal perspective, the ICER is €27,494/LYG using a friction cost approach and €16,112/LYG using a human capital approach. Deterministic sensitivity analyses demonstrated that the estimate was robust against changes in the input parameters and probabilistic sensitivity analysis suggested that the probability EHMD was cost-effective at a threshold of €45,790/LYG was 94.8 percent. Adopting EHMD as the standard approach to nutrition is a cost-effective intervention for very low birth weight newborns in Germany.
Highlights
New-borns with very low birth weight show an increased risk of necrotising enterocolitis (NEC) [1], systemic sepsis [2, 3] and other clinical complications that may lead to infant mortality, short-term complications or even persistent, life-long sequelae
The exclusive human milk diet (EHMD) was estimated to be cost-effective compared to the current nutrition for very low birth weight newborns with an incremental cost-effectiveness ratio (ICER) of €28,325 per Life-Year-Gained (LYG)
Deterministic sensitivity analyses demonstrated that the estimate was robust against changes in the input parameters and probabilistic sensitivity analysis suggested that the probability EHMD was cost-effective at a threshold of €45,790/LYG was 94.8 percent
Summary
New-borns with very low birth weight show an increased risk of necrotising enterocolitis (NEC) [1], systemic sepsis [2, 3] and other clinical complications that may lead to infant mortality, short-term complications or even persistent, life-long sequelae. These include bronchopulmonary dysplasia (BPD) [4, 5], retinopathy of prematurity (RoP) and neurodevelopmental problems [6]. The feeding of very low birth weight babies with this exclusive human milk diet (EHMD) has shown a reduction in NEC, sepsis, BPD, RoP and mortality compared to cow milk-based nutrition [18,19,20,21]
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