RT Journal Article
SR Electronic
T1 Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT)
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 587
OP 592
DO 10.1136/archdischild-2019-318346
VO 105
IS 6
A1 Tahir, Warda
A1 Monahan, Mark
A1 Dorling, Jon
A1 Hewer, Oliver
A1 Bowler, Ursula
A1 Linsell, Louise
A1 Partlett, Christopher
A1 Berrington, Janet Elizabeth
A1 Boyle, Elaine
A1 Embleton, Nicolas
A1 Johnson, Samantha
A1 Leaf, Alison
A1 McCormick, Kenny
A1 McGuire, William
A1 Stenson, Ben J
A1 Juszczak, Ed
A1 Roberts, Tracy E
YR 2020
UL http://fn.bmj.com/content/105/6/587.abstract
AB 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.