Abstract
ObjectivesTo estimate the cost savings and health benefits in the UK NHS that could be achieved if human milk usage in the NICU was increased.MethodsA systematic review established the disease areas with the strong sources of evidence of the short, medium and long-term benefits of human milk for preterm infants as opposed to the use of formula milk. The analysis assessed the economic impact of reducing rates of necrotising enterocolitis, sepsis, sudden infant death syndrome, leukaemia, otitis media, obesity and neurodevelopmental impairment.ResultsBased on the number of preterm babies born in 2013, if 100% of premature infants being fed mother’s milk could be achieved in the NICU, the total lifetime cost savings to the NHS due to improved health outcomes is estimated to be £46.7 million (£30.1 million in the first year) with a total lifetime QALY gain of 10,594, There would be 238 fewer deaths due to neonatal infections and SIDS, resulting in a reduction of approximately £153.4 million in lifetime productivity. Sensitivity analyses indicated that results were robust to a wide range of inputs.ConclusionsThis analysis established that increasing the use of human milk in NICUs in the UK would lead to cost savings to the NHS. More research is needed on the medium and long term health and economic outcomes associated with breastfeeding preterm infants, and the differences between mother’s own and donor breast milk.
Highlights
The benefits of human milk for both preterm and term infants are well established in the medical literature, with evidence demonstrating that human milk can aid development and reduce risks of certain infections [1].The World Health Organization (WHO) recommends exclusive breastfeeding for at least the first 6 months of life to provide adequate nutrition for infant development [2, 3]
845 records were reviewed for further assessment. As this is a pragmatic review with the purpose of identifying evidence for benefits of human milk and/or breastfeeding, only the most recent reviews reporting either a specific outcome or at one of our three time points of interest were included
Other reviews were only considered for inclusion if they provided either information from different individual studies or on different outcomes at the same time point
Summary
The benefits of human milk for both preterm and term infants are well established in the medical literature, with evidence demonstrating that human milk can aid development and reduce risks of certain infections [1].The World Health Organization (WHO) recommends exclusive breastfeeding for at least the first 6 months of life to provide adequate nutrition for infant development [2, 3]. Mothers with preterm infants face further barriers to breastfeeding. In the UK, the rate of exclusive breastfeeding at discharge for preterm infants has been found to be as low as 29% and for exclusive of mixed breastfeeding as low as 35% [7]. In these circumstances, feeding with donor breastmilk from other lactating mothers has been shown to have benefits over feeding formula milk, such as a lower risk of necrotising enterocolitis (NEC) in the infant due to the presence of active enzymes and anti-infective properties in the breastmilk [8]
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