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Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)
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  • Published on:
    Response to Comments on the analyses and the generalizability of findings from the Economic Evaluation of SIFT
    • Tracy E Roberts, Professor of Health Economics Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    We thank the authors for the comments on the Economic Evaluation of SIFT (1) and we are grateful for the opportunity to respond to their comments.
    Taking each of the authors’ points in the order in which they are presented:
    1. In relation to the first point about the loss to follow up and the exclusion of such patients from the analysis, we point out that we used complete case analysis and accounted for the missing patients following best practice using a multiple imputation analysis which is provided in the supplementary materials. We state the following in the paper:

    “Mean total costs for all infants, adjusting for missing data using multiple imputation, are found in the online supplementary table S3. When the missing values were accounted for, faster feed increments remain more costly in comparison to slower feed increments but at a slightly higher level (£378 more) per infant, reflecting the high level of uncertainty in the difference in costs, especially with regard to the healthcare resource use after discharge estimated by the multiple imputation” (last paragraph of methods))

    2. In relation to the authors second concern, whilst death was slightly higher in the slower feeds arm during initial hospital stay there are two important points in response to this. First, we clarify that by definition economic analysis is not an exercise in accountancy where death is assumed to incur a zero cost, because economic evaluation focuses on costs and ou...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comments on the analyses and the generalizability of findings from the Economic Evaluation of SIFT
    • Manoj Kumar, Staff Neonatologist Department of Pediatrics, University of Alberta, Edmonton, Canada

    I read with interest the economic evaluation of Speed of Increasing milk Feeds Trial (SIFT) in preterm infants presented by Tahir and colleagues.(1) While the clinical findings from the SIFT had shown short-term benefits such as lesser TPN days with faster feed increments, and was equivocal for the composite primary outcome of death and disability measured at 24 months, this analysis recommends against faster feed increments based on the cost-effectiveness analyses. The average total costs is shown to be marginally higher for subjects in this arm, with a mean difference of £267 (0.25%). I highlight below many issues that probably affect the conclusions, and the generalizability of the findings, of this economic evaluation.

    First, the trial enrolled 1394 and 1399 patients in the two study arms. However, the cost data of initial hospitalization is presented for 1224 and 1246 patients in these arms. It seems that 170 and 153 patients from the two trial arms were lost to follow-up after the initial hospitalization;(2) however, the data for these subjects should not be excluded while calculating the average initial hospitalization costs per subject.

    Second, more deaths during the initial hospitalization were reported in the slower increment arm and those probably lowered the average cost for this arm. It is well known that the hospitalization costs for very preterm infants that die during the neonatal period are substantially lower than those of the survivors....

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    Conflict of Interest:
    None declared.