An exclusive human milk diet for very low birth weight newborns—A cost-effectiveness and EVPI study for Germany
Autoři:
Stefan Michael Scholz aff001; Wolfgang Greiner aff001
Působiště autorů:
Department of Health Economics and Health Management, School of Public Health, Bielefeld University, Bielefeld, Germany
aff001
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0226496
Souhrn
Objectives
Human milk-based fortifiers have shown a protective effect on major complications for very low birth weight newborns. The current study aimed to estimate the cost-effectiveness of an exclusive human milk diet (EHMD) compared to the current approach using cow’s milk-based fortifiers in very low birth weight newborns.
Methods
A decision tree model using the health states of necrotising enterocolitis (NEC), sepsis, NEC + sepsis and no complication was used to calculate the cost-effectiveness of an EHMD. For each health state, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (RoP) and neurodevelopmental problems were included as possible complications; additionally, short-bowel syndrome (SBS) was included as a complication for surgical treatment of NEC. The model was stratified into birth weight categories. Costs for inpatient treatment and long-term consequences were considered from a third party payer perspective for the reference year 2017. Deterministic and probabilistic sensitivity analyses were performed, including a societal perspective, discounting rate and all input parameter-values.
Results
In the base case, the EHMD was estimated to be cost-effective compared to the current nutrition for very low birth weight newborns with an incremental cost-effectiveness ratio (ICER) of €28,325 per Life-Year-Gained (LYG). From a societal perspective, the ICER is €27,494/LYG using a friction cost approach and €16,112/LYG using a human capital approach. Deterministic sensitivity analyses demonstrated that the estimate was robust against changes in the input parameters and probabilistic sensitivity analysis suggested that the probability EHMD was cost-effective at a threshold of €45,790/LYG was 94.8 percent.
Conclusion
Adopting EHMD as the standard approach to nutrition is a cost-effective intervention for very low birth weight newborns in Germany.
Klíčová slova:
Birth weight – Cost-effectiveness analysis – Infants – Milk – Neonates – Pediatric surgery – Pediatrics – Sepsis
Zdroje
1. Mϋller MJ, Paul T, Seeliger S. Necrotizing enterocolitis in premature infants and newborns. J Neonatal Perinatal Med. 2016;9:233–42. doi: 10.3233/NPM-16915130 27589549
2. Schwab F, Zibell R, Piening B, Geffers C, Gastmeier P. Mortality due to bloodstream infections and necrotizing enterocolitis in very low birth weight infants. Pediatr Infect Dis J. 2015;34:235–40. doi: 10.1097/INF.0000000000000532 25742073
3. Tröger B, Göpel W, Faust K, Müller T, Jorch G, Felderhoff-Müser U, et al. Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network. Pediatr Infect Dis J. 2014;33:238–43. doi: 10.1097/INF.0000000000000031 24030351
4. Schmalisch G, Wilitzki S, Roehr CC, Proquitté H, Bührer C. Development of lung function in very low birth weight infants with or without bronchopulmonary dysplasia: longitudinal assessment during the first 15 months of corrected age. BMC Pediatr. 2012;12:37. doi: 10.1186/1471-2431-12-37 22443188
5. Mailaparambil B, Krueger M, Heizmann U, Schlegel K, Heinze J, Heinzmann A. Genetic and epidemiological risk factors in the development of bronchopulmonary dysplasia. Dis Markers. 2010;29:1–9. doi: 10.3233/DMA-2010-0720 20826912
6. Martin CR, Dammann O, Allred EN, Patel S, O’Shea TM, Kuban KCK, Leviton A. Neurodevelopment of extremely preterm infants who had necrotizing enterocolitis with or without late bacteremia. J Pediatr. 2010;157:751–6.e1. doi: 10.1016/j.jpeds.2010.05.042 20598317
7. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. JAMA. 2015;314:1039–51. doi: 10.1001/jama.2015.10244 26348753
8. IQTIG. Bundesauswertung zum Erfassungsjahr 2017—Geburtshilfe: Qualitätsindikatoren; 01.08.2018.
9. McGuire W, Anthony MY. Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review. Arch Dis Child Fetal Neonatal Ed. 2003;88:F11–4. doi: 10.1136/fn.88.1.F11 12496220
10. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol. 2009;29:57–62. doi: 10.1038/jp.2008.117 18716628
11. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O’Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27:428–33. doi: 10.1038/sj.jp.7211758 17443195
12. Good M, Sodhi CP, Hackam DJ. Evidence-based feeding strategies before and after the development of necrotizing enterocolitis. Expert Rev Clin Immunol. 2014;10:875–84. doi: 10.1586/1744666X.2014.913481 24898361
13. Reisinger KW, de Vaan L, Kramer BW, Wolfs TGAM, van Heurn LWE, Derikx JPM. Breast-feeding improves gut maturation compared with formula feeding in preterm babies. J Pediatr Gastroenterol Nutr. 2014;59:720–4. doi: 10.1097/MPG.0000000000000523 25111221
14. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2014:CD002971. doi: 10.1002/14651858.CD002971.pub3 24752468
15. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14:216. doi: 10.1186/1471-2431-14-216 25174435
16. Jochum F, Krohn K, Kohl M, Loui A, Nomayo A, Koletzko B. S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), die Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und die Gesellschaft für Neonatologie und pädiatrische Intensivmedizin (GNPI). Aktuel Ernahrungsmed. 2014;39:e99–e147. doi: 10.1055/s-0034-1370222
17. Arslanoglu S, Corpeleijn W, Moro G, Braegger C, Campoy C, Colomb V, et al. Donor human milk for preterm infants: current evidence and research directions. J Pediatr Gastroenterol Nutr. 2013;57:535–42. doi: 10.1097/MPG.0b013e3182a3af0a 24084373
18. Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S, Trawoeger R, Kiechl-Kohlendorfer U, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163:1592–1595.e1. doi: 10.1016/j.jpeds.2013.07.011 23968744
19. Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawöger R, Kiechl-Kohlendorfer U, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156:562–7.e1. doi: 10.1016/j.jpeds.2009.10.040 20036378
20. Abrams SA, Schanler RJ, Lee ML, Rechtman DJ. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products. Breastfeed Med. 2014;9:281–5. doi: 10.1089/bfm.2014.0024 24867268
21. O’Connor DL, Kiss A, Tomlinson C, Bando N, Bayliss A, Campbell DM, et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr. 2018;108:108–16. doi: 10.1093/ajcn/nqy067 29878061
22. DRG Research Group. Webgrouper. 2017. http://drg.uni-muenster.de/index.php?option=com_webgrouper&view=webgrouper&Itemid=112.
23. Baumgardt M, Bucher HU, Szucs TD, Fauchère JC. Lebensqualität, Therapiebeanspruchung und Kosten von Frühgeborenen mit einem Geburtsgewicht <1250g im Vergleich zu Termingeborenen–Eine Untersuchung im Erwachsenenalter. Klin Padiatr 2010. doi: 10.1055/s-0030-1261379
24. Guillet R, Stoll BJ, Cotten CM, Gantz M, McDonald S, Poole WK, Phelps DL. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2006;117:e137–42. doi: 10.1542/peds.2005-1543 16390920
25. NRZ. KISS Krankenhaus-Infektions-Surveillance-System: Modul NEO-KISS Referenzdaten; 10.05.2017.
26. Jeschke E, Biermann A, Günster C, Böhler T, Heller G, Hummler HD, Bührer C. Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008–2012: A Report Based on Administrative Data. Front Pediatr. 2016;4:23. doi: 10.3389/fped.2016.00023 27047906
27. Cole CR, Hansen NI, Higgins RD, Ziegler TR, Stoll BJ. Very low birth weight preterm infants with surgical short bowel syndrome: incidence, morbidity and mortality, and growth outcomes at 18 to 22 months. Pediatrics. 2008;122:e573–82. doi: 10.1542/peds.2007-3449 18762491
28. Jo HS, Cho KH, Cho S-I, Song ES, Kim BI. Recent Changes in the Incidence of Bronchopulmonary Dysplasia among Very-Low-Birth-Weight Infants in Korea. J Korean Med Sci. 2015;30 Suppl 1:S81–7. doi: 10.3346/jkms.2015.30.S1.S81 26566362
29. Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2007;92:F193–8. doi: 10.1136/adc.2006.099929 16984980
30. AQUA-Institut GmbH. Qualitätsreport 2012; 2013.
31. AQUA-Institut GmbH. Qualitätsreport 2013; 2014.
32. AQUA-Institut GmbH. Qualitätsreport 2014; 2015.
33. IQTIG. Bundesauswertung zum Erfassungsjahr 2016—Neonatologie: Qualitätsindikatoren; 12.07.2017.
34. IQTIG. Bundesauswertung zum Erfassungsjahr 2015—Neonatologie: Qualitätsindikatoren; 07.07.2016.
35. Sonntag J. Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis. SPAE. 2000;89:528–32. doi: 10.1080/080352500750027790 10852186
36. Stichtenoth G, Demmert M, Bohnhorst B, Stein A, Ehlers S, Heitmann F, et al. Major contributors to hospital mortality in very-low-birth-weight infants: data of the birth year 2010 cohort of the German Neonatal Network. Klin Padiatr. 2012;224:276–81. doi: 10.1055/s-0032-1306344 22441803
37. Texas Children’s Hospital. Feeding Protocol with Cream. 23rd ed.; 2017.
38. Hair AB, Peluso AM, Hawthorne KM, Perez J, Smith DP, Khan JY, et al. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet. Breastfeed Med. 2016;11:70–4. doi: 10.1089/bfm.2015.0134 26789484
39. Statistisches Bundesamt. Krankenhausstatistik. 2017. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dboowasys921.xwdevkit/xwd_init?gbe.isgbetol/xs_start_neu/&p_aid=3&p_aid=88658613&nummer=702&p_sprache=D&p_indsp=-&p_aid=99250666#SOURCES.
40. GKV Spitzenverband. Bundesbasisfallwert (BBFW). 2018. https://www.gkv-spitzenverband.de/krankenversicherung/krankenhaeuser/budgetverhandlungen/bundesbasisfallwert/bundesbasisfallwert.jsp.
41. Scholz S, Meszaros K, Fassbender RM, Welte R, Greiner W, Koerber F. The Cost Of Illness For Invasive Meningococcal B Disease In Germany. Value in Health. 2017;20:A785. doi: 10.1016/j.jval.2017.08.2290
42. Bundesagentur für Arbeit. Arbeitsmarkt 2015: Arbeitsmarktanalyse für Deutschland, West- und Ostdeutschland. Nürnberg; August 2016.
43. Institute for Quality and Efficiency in Health Care. Allgemeine Methoden: Entwurf für Version 5.0 vom 07.12.2016.
44. OECD. Gross domestic product (GDP) 2017 (indicator). 2018. Accessed 8 Oct 2018.
45. OECD. Exchange rates 2017 (indicator). 2018.
46. Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ. 2015;93:118–24. doi: 10.2471/BLT.14.138206 25883405
47. Song J, Floyd FJ, Seltzer MM, Greenberg JS, Hong J. Long-term Effects of Child Death on Parents’ Health Related Quality of Life: A Dyadic Analysis. Fam Relat. 2010;59:269–82. doi: 10.1111/j.1741-3729.2010.00601.x 20676393
48. Al-Janabi H, van Exel J, Brouwer W, Trotter C, Glennie L, Hannigan L, Coast J. Measuring Health Spillovers for Economic Evaluation: A Case Study in Meningitis. Health Econ. 2016;25:1529–44. doi: 10.1002/hec.3259 26464311
Článek vyšel v časopise
PLOS One
2019 Číslo 12
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Je libo čepici místo mozkového implantátu?
- Pomůže v budoucnu s triáží na pohotovostech umělá inteligence?
- AI může chirurgům poskytnout cenná data i zpětnou vazbu v reálném čase
- Nová metoda odlišení nádorové tkáně může zpřesnit resekci glioblastomů
Nejčtenější v tomto čísle
- Methylsulfonylmethane increases osteogenesis and regulates the mineralization of the matrix by transglutaminase 2 in SHED cells
- Oregano powder reduces Streptococcus and increases SCFA concentration in a mixed bacterial culture assay
- The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria
- Parametric CAD modeling for open source scientific hardware: Comparing OpenSCAD and FreeCAD Python scripts
Zvyšte si kvalifikaci online z pohodlí domova
Všechny kurzy