Economic evaluation alongside the Speed of Increasing Milk Feeds Trial (SIFT)
Economic evaluation alongside the Speed of Increasing Milk Feeds Trial (SIFT)
Objective: to evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants.
Design: within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial).
Setting: 55 UK neonatal units from May 2013 to June 2015.
Patients: infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible.
Interventions: when clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control).
Main outcome measure: cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity.
Results: average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds.
Conclusions: the stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome.
health economics, infant Feeding, neonatology
587-592
Tahir, Warda
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Monahan, Mark
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Dorling, Jon
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Hewer, Oliver
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Bowler, Ursula
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Linsell, Louise
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Partlett, Christopher
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Berrington, Janet Elizabeth
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Boyle, Elaine
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Embleton, Nicolas
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Johnson, Samantha
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Leaf, Alison
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McCormick, Kenny
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McGuire, William
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Stenson, Ben J.
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Juszczak, Ed
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Roberts, Tracy E.
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21 October 2020
Tahir, Warda
2a3730d3-481a-4f2c-ada0-217a6940073b
Monahan, Mark
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Dorling, Jon
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Hewer, Oliver
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Bowler, Ursula
49570c44-66b8-4121-a220-3de7e6cf1a0d
Linsell, Louise
bf220517-49cd-4fbb-8666-19d2a1de1257
Partlett, Christopher
ff1ea90b-5254-4a96-809a-14d05b13a0d7
Berrington, Janet Elizabeth
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Boyle, Elaine
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Embleton, Nicolas
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Johnson, Samantha
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Leaf, Alison
dcf14c67-b3d2-43b5-81ce-595c194e405b
McCormick, Kenny
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McGuire, William
aed9d25e-dc0a-4813-96e1-156c268e005c
Stenson, Ben J.
21656459-9347-4ac8-8429-cb11c27dad37
Juszczak, Ed
a4f66edd-e590-4ba4-8aba-cc8f1fd955aa
Roberts, Tracy E.
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Tahir, Warda, Monahan, Mark, Dorling, Jon, Hewer, Oliver, Bowler, Ursula, Linsell, Louise, Partlett, Christopher, Berrington, Janet Elizabeth, Boyle, Elaine, Embleton, Nicolas, Johnson, Samantha, Leaf, Alison, McCormick, Kenny, McGuire, William, Stenson, Ben J., Juszczak, Ed and Roberts, Tracy E.
(2020)
Economic evaluation alongside the Speed of Increasing Milk Feeds Trial (SIFT).
Archives of Disease in Childhood: Fetal and Neonatal Edition, 105 (6), .
(doi:10.1136/archdischild-2019-318346).
Abstract
Objective: to evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants.
Design: within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial).
Setting: 55 UK neonatal units from May 2013 to June 2015.
Patients: infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible.
Interventions: when clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control).
Main outcome measure: cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity.
Results: average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds.
Conclusions: the stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome.
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More information
Accepted/In Press date: 4 February 2020
e-pub ahead of print date: 2 April 2020
Published date: 21 October 2020
Additional Information:
Funding Information:
funding This paper presents independent research commissioned by the National Institute for Health Research (NIHR). Funded by the Health Technology Assessment Programme of the National Institute for Health Research; ISRCTN registration number ISRCTN76463425.
Keywords:
health economics, infant Feeding, neonatology
Identifiers
Local EPrints ID: 485000
URI: http://eprints.soton.ac.uk/id/eprint/485000
ISSN: 1359-2998
PURE UUID: 8e8ac57c-e803-4471-b739-fab2fc90ee40
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Date deposited: 27 Nov 2023 18:38
Last modified: 18 Mar 2024 04:16
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Contributors
Author:
Warda Tahir
Author:
Mark Monahan
Author:
Jon Dorling
Author:
Oliver Hewer
Author:
Ursula Bowler
Author:
Louise Linsell
Author:
Christopher Partlett
Author:
Janet Elizabeth Berrington
Author:
Elaine Boyle
Author:
Nicolas Embleton
Author:
Samantha Johnson
Author:
Alison Leaf
Author:
Kenny McCormick
Author:
William McGuire
Author:
Ben J. Stenson
Author:
Ed Juszczak
Author:
Tracy E. Roberts
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