Departments of Nutritional Sciences.
Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada.
Pediatrics. 2018 Mar;141(3). doi: 10.1542/peds.2017-0737.
To determine the cost-effectiveness of supplemental donor human milk (DHM) versus preterm formula (PTF) for very low birth weight (VLBW, <1500 g) infants from a societal perspective to 18 months' corrected age.
This prospective cost-effectiveness analysis of 363 VLBW infants was conducted for a randomized control trial. Infants recruited from October 2010 to December 2012 were fed DHM or PTF whenever mother's milk was unavailable. Formal health care costs for initial hospitalization and readmissions were obtained from standardized cost-accounting systems and physician fees. Informal and nonhealth care sector costs (eg, caregiver transportation, labor market earnings) were calculated from parent reports.
Mean infant birth weight was 996 (SD, 272) grams. Incidence of necrotizing enterocolitis (NEC) differed between groups (all stages 3.9% DHM, 11.0% PTF; = .01). Costs to 18 months did not differ with a mean (95% confidence interval) of 217 624 (197 697-237 551) and 217 245 (196 494-237 995) 2015 Canadian dollars in the DHM and PTF groups. Postdischarge costs were lower in the DHM (46 440 [40 648-52 233]) than PTF group (55 102 [48 269-61 934]) ( = .04), driven by parent lost wages. DHM cost an additional $5328 per case of averted NEC.
In a high mother's milk use setting, total costs from a societal perspective to 18 months of providing supplemental DHM versus PTF to VLBW infants did not differ, although postdischarge costs were lower in the DHM group. Although supplemental DHM was not cost-saving, it reduced NEC supporting its use over PTF.
从社会角度出发，以 18 个月的校正年龄为时间点，比较补充人乳（DHM）和早产儿配方（PTF）对极低出生体重（VLBW，<1500g）婴儿的成本效益。
对 2010 年 10 月至 2012 年 12 月期间参加一项随机对照试验的 363 名 VLBW 婴儿进行前瞻性成本效益分析。招募的婴儿如果母乳无法提供，就会接受 DHM 或 PTF 喂养。初始住院和再次入院的正式医疗费用由标准化成本核算系统和医生费用获得。非正式和非医疗部门的成本（如护理人员交通、劳动力市场收入）则由家长报告计算。
婴儿平均出生体重为 996（SD，272）克。两组的坏死性小肠结肠炎（NEC）发病率不同（所有阶段为 3.9%的 DHM，11.0%的 PTF；P=0.01）。到 18 个月时，两组的成本没有差异，DHM 组的平均（95%置信区间）为 217624（197697-237551）加元，PTF 组为 217245（196494-237995）加元。DHM 组的出院后成本（46440 [40648-52233]）低于 PTF 组（55102 [48269-61934]）（P=0.04），这是由父母的工资损失驱动的。DHM 每例预防 NEC 的成本增加 5328 美元。
在高母乳喂养使用率的情况下，从社会角度来看，为 VLBW 婴儿提供补充 DHM 与 PTF 至 18 个月的总成本没有差异，尽管 DHM 组的出院后成本较低。虽然补充 DHM 没有节省成本，但它降低了 NEC 的发病率，支持其优于 PTF 的使用。
