The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit

J Pediatr. 2020 Sep:224:57-65.e4. doi: 10.1016/j.jpeds.2020.04.044. Epub 2020 Jul 15.


Objective: To assess the cost-effectiveness of mother's own milk supplemented with donor milk vs mother's own milk supplemented with formula for infants of very low birth weight in the neonatal intensive care unit (NICU).

Study design: A retrospective analysis of 319 infants with very low birth weight born before (January 2011-December 2012, mother's own milk + formula, n = 150) and after (April 2013-March 2015, mother's own milk + donor milk, n = 169) a donor milk program was implemented in the NICU. Data were retrieved from a prospectively collected research database, the hospital's electronic medical record, and the hospital's cost accounting system. Costs included feedings and other NICU costs incurred by the hospital. A generalized linear regression model was constructed to evaluate the impact of feeding era on NICU total costs, controlling for neonatal and sociodemographic risk factors and morbidities. An incremental cost-effectiveness ratio was calculated for each morbidity that differed significantly between feeding eras.

Results: Infants receiving mother's own milk + donor milk had a lower incidence of necrotizing enterocolitis (NEC) than infants receiving mother's own milk + formula (1.8% vs 6.0%, P = .048). Total (hospital + feeding) median costs (2016 USD) were $169 555 for mother's own milk + donor milk and $185 740 for mother's own milk + formula (P = .331), with median feeding costs of $1317 and $936, respectively (P < .001). Mother's own milk + donor milk was associated with $15 555 lower costs per infant (P = .045) and saved $1812 per percentage point decrease in NEC incidence.

Conclusions: The additional cost of a donor milk program was small compared with the cost of a NICU hospitalization. After its introduction, the NEC incidence was significantly lower with small cost savings per case. We speculate that NICUs with greater NEC rates may have greater cost savings.

Keywords: cost-effectiveness; donor milk program; healthcare costs; hospital costs; mother's own milk; necrotizing enterocolitis; very low birth weight.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Breast Feeding / economics
  • Cost-Benefit Analysis
  • Humans
  • Infant Formula / economics
  • Infant, Newborn
  • Infant, Premature, Diseases / prevention & control
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal / economics*
  • Milk Banks / economics*
  • Milk, Human*
  • Retrospective Studies