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Original research
Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)
  1. Warda Tahir1,
  2. Mark Monahan1,
  3. Jon Dorling2,
  4. Oliver Hewer3,
  5. Ursula Bowler3,
  6. Louise Linsell4,
  7. Christopher Partlett5,
  8. Janet Elizabeth Berrington6,
  9. Elaine Boyle7,
  10. Nicolas Embleton8,
  11. Samantha Johnson9,
  12. Alison Leaf10,
  13. Kenny McCormick11,
  14. William McGuire12,
  15. Ben J Stenson13,
  16. Ed Juszczak14,
  17. Tracy E Roberts15
  1. 1 University of Birmingham, Birmingham, UK
  2. 2 Division of Neonatal-Perinatal Medicine, Dalhousie University—Faculty of Medicine, Halifax, Nova Scotia, Canada
  3. 3 National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  4. 4 National Perinatal epidemiology Unit, University of Oxford, Oxford, UK
  5. 5 Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
  6. 6 Neonatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  7. 7 Department of Health Sciences, University of Leicester, Leicester, UK
  8. 8 Newcastle University, Newcastle upon Tyne, UK
  9. 9 University of Leicester, Leicester, UK
  10. 10 Neonatal Medicine, Southmead Hospital, Bristol, UK
  11. 11 John Radcliffe Hospital, Oxford, Oxfordshire, UK
  12. 12 Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
  13. 13 Neonatology, Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
  14. 14 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  15. 15 Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Tracy E Roberts, Health Economics Unit, School of Health and Populations Science, University of Birmingham, Birmingham B15 2TT, UK; t.e.roberts{at}bham.ac.uk

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.

  • health economics
  • infant Feeding
  • neonatology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/archdischild-2019-318346

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    Footnotes

    • Contributors WT was the lead author of the manuscript and was supervised in this role by TER and MM. This manuscript was written in collaboration with both TER and MM. All other authors contributed to editing and revising the manuscript.

    • 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.

    • Disclaimer The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the Health Technology Assessment Programme or the Department of Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. N/A.