Abstract
BackgroundBreastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK.MethodsA decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion.ResultsThe incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16–26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40–£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35–40%.ConclusionsAvailable breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.
Highlights
Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service
The analysis presented here is part of the work that informed the updating of national guidance on postnatal care in England, published by the National Institute for Health and Care Excellence (NICE) [12]
The intervention had better outcomes and resulted in cost-savings across all conditions examined, when added on standard care compared with standard care alone
Summary
Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK. Existing evidence on the cost-effectiveness of such interventions is limited and has not considered the long-term benefits to women and their babies and related costsavings associated with breastfeeding [7,8,9,10,11]. The objective of this study was to examine the long-term cost-effectiveness of interventions for women, initiated antenatally or in the first 8 weeks after birth, aimed at promoting initiation and/or maintenance of breastfeeding from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England, using decision-analytic economic modelling
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