The Economics of Human Milk in Very Low Birth Weight Infants

28 February 2017

Tricia Johnson, PhD Economist, Rush University Medical Center

Chicago, USA

There are many cost implications associated with human milk for very low birth weight infants

Initial Neonatal Intensive Care Unit Stay

Reduction in incidence of costly morbidities and their associated healthcare costs - Necrotizing enterocolitis (NEC) - Late onset sepsis - Bronchopulmonary dysplasia (BPD) - Retinopathy of prematurity - Enteral feeding intolerance

Source: Patel et al. 2012; Schanler et al. 1999; Schanler et al. 2005; Sisk et al. 2007; Sisk et al. 2008; Furman et al. 2003; Meinzen-Derr et al. 2004; De Silva et al. 2004; Mahon et al, 2016

Infancy and Childhood

Reduction in downstream healthcare needs associated with NICU morbidities

Reduction in risk of costly health conditions and their associated costs • Leukemia • Otitis media • Obesity • Sudden infant death syndrome

LOVE MOM Cohort

3

Longitudinal Outcomes in Very Low Birth Weight Infants Exposed to Mothers’ Own Milk

- PI: Paula Meier (NIH, NR010009) - Prospective cohort of 430 VLBW infants born 2008 – 2012 - Infants less than 1500g birth weight - Primarily minority - Predominantly low income

Morbidities substantially increase cost of NICU hospitalization

4

• Average NICU hospital cost (in 2010 dollars) for infants with no morbidities: $40,227 ± 16,905

• 39% of infants have 1 morbidity

• 31% of infants have 2 or more morbidities

• Costs increase substantially with each morbidity

• Multiple morbidities may have more than an additive impact on costs

Source: Johnson et al. 2013

Low HM volume in first 28 days of

life (DOL)

The Mother’s Own Milk – Formula Trade-Off

Supplement with formula

↑ risk of late-onset sepsis

5

Supplement with any formula ↑ risk of NEC

Low HM volume in first 14 DOL

Supplement with formula

↑ risk of bronchopulmonary

dysplasia

Low HM volume through 36 weeks GA or discharge

+$41,929 per case

+$43,818 per case

+$10,055 per case

Source: Johnson et al, 2013; Patel et al, 2013; Johnson et al, 2015; Patel et al, 2016

Economic Barriers to the Initiation & Maintenance of Lactation

6Source: Meier et al, 2017; costs in 2015 US Dollars

Barrier

Evidence-based materials on HM for preterm infants

Hospital grade electric breast pump rental, 3 months

Pump kit

Custom-fitted breast shields

Hospital-grade HM storage containers

NICU-specific lactation support from NICU-based certified Breastfeeding Peer Counselors

NICU freezers for safe storage of pumped HM

HM waterless warmers

Liners for waterless warmers

Basic creamatocrit and/or other HM analysis technology to individualize HM feedings & HM collection strategies

Infant scales for measuring HM intake

Economic Barriers to the Initiation & Maintenance of Lactation

7Source: Meier et al, 2017; costs in 2015 US Dollars

Barrier Cost (USD) per Infant

Evidence-based materials on HM for preterm infants $16

Hospital grade electric breast pump rental, 3 months $210

Pump kit $33

Custom-fitted breast shields $7

Hospital-grade HM storage containers $134

NICU-specific lactation support from NICU-based certified Breastfeeding Peer Counselors

$539

NICU freezers for safe storage of pumped HM $10

HM waterless warmers $50

Liners for waterless warmers $231

Basic creamatocrit and/or other HM analysis technology to individualize HM feedings & HM collection strategies

$1

Infant scales for measuring HM intake $6

Costs versus Benefits of Human Milk Provision for VLBW Infants in the NICU

8

+$1,238

Cost of providing support for lactation initiation

and maintenanceBenefit to infant in NICU

ê NEC ê Sepsis ê BPD

Source: Johnson et al, 2013; Patel et al, 2013; Johnson et al, 2015; Patel et al, 2016; Meier et al, 2017

Contact Information

9

Tricia Johnson, PhD Rush University Medical Center Department of Health Systems Management 1700 West Van Buren Street Chicago, IL 60612 Tricia_J_Johnson@rush.edu +1 312 942 7107