Association of Exclusive Human Milk Feeding Using Commercial Donor Milk with Reduction in Estimated Hospital Charges for Necrotizing Enterocolitis and Late-Onset Sepsis in VLBW Infants

Monday, October 26, 2015: 1:27 PM
Marquis Salon 6 (Marriott Marquis)
Monica L. Huff, MD and Karen E. Shattuck, MD, University of Texas Medical Branch, Galveston, TX

Purpose

A diet of exclusive human milk (EHM) has been suggested as one strategy to decrease the incidence of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. In 2012, analysis at UTMB indicated that the charges of providing an exclusive human milk (EHM) diet using commercial donor human milk (CDHM) to supplement the limited availability of maternal expressed breast milk (EBM) would achieve cost neutrality if the incidence of necrotizing enterocolitis (NEC) was reduced by 67% in VLBW babies. In March 2013, we instituted a policy of providing a diet of CDHM or EBM fortified with liquid human milk fortifier for all VLBW infants less than 32 weeks gestation at birth. In this study, we determined the cost-effectiveness of this strategy.

Methods

Incidences of medical NEC (Bell Stage I-II), surgical NEC (Bell III) , and late onset sepsis (LOS) for the years 2009-2011 (baseline period, receiving mother's milk or standard preterm formula) were compared to the 12 month period June 2013-May 2014 (EHM) in VLBW and less than 32 weeks PMA infants. Published charge estimates for LOS and NEC were used to calculate estimated annual diagnosis-related hospital charges. CDHM and human milk fortifier costs were obtained from UTMB hospital purchasing records.

Results

During 2009-2011 (36 months), there were 11.3 4.9 cases of medical NEC (mean annual incidence 12.5%, range 8.8-19.1%) and 13.3 6.0 cases of LOS (mean annual incidence 14.6%, range 7.9-20.9%) with associated costs of $838,465 and $134,033, respectively. There was one case of surgical NEC in each year. For infants on EHM diets in 2013-14, the incidence of medical NEC and of LOS was 3.2% (each occurred in 3 infants) resulting in a 73% and 77% reduction in cases. There were no cases of surgical NEC.

Diagnosis

Diagnosis Charge

Before EHM Annual cases

(mean)

Before EHM

Annual Charges for Diagnosis

(mean)

After EHM

Annual cases

After EHM

Annual charge for Diagnosis

Charge Savings

(estimated)

Medical NEC

$74,004.00

11.33

$838,465.32

3

$222,012.00

$616,453.32

Surgical NEC

$198,040.00

1.00

$198,040.00

0

0

$198,040.00

Sepsis

$10,055.00

13.33

$134,033.15

3

$30,165.00

$103,868.15

 

$1,170,538.47

$252,177.00

$918,361.47

 

Total reduction in morbidity-associated charges: $918,361.47

Savings estimate in hospital charges associated with an EHM diet adjusted for costs of CDHM and human milk fortifier: $431,080.87

Conclusion

Providing an EHM diet (CDHM or maternal milk with human-milk fortifier) was associated with a reduction in NEC and LOS in our Level III NICU. There were NO cases of surgical NEC in the initial year of providing EHM. After adjusting for the cost of CDHM, the reduction in estimated annual hospital charges was $431,081.

 

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