Substudy 12 Fact Sheet

Cost Effectiveness of Home Versus Hospital Support of Breast Feeding in Neonates (NA101-12)

Sponsor Organization:
University of Toronto

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). The benefits of breast feeding are well established, and most Canadian mothers initially intend to breast feed their infants whether they are born at term or preterm. However, the establishment of breast feeding within the first 72 hours of life may be a challenge in full term infants and is particularly difficult in preterm infants. At the same time, hospitals are under significant pressure to develop alternative models of service delivery, with a growing emphasis on care delivered in a home environment. The purpose of this study was to examine the costs associated with supporting mothers to establish breast feeding of term and preterm infants in both home and hospital contexts. Efficacy, safety, level of maternal satisfaction, and resources involved in the management of breast feeding were also considered.

Activities:
This study was conducted in one postpartum unit of a metropolitan teaching hospital, with a sample size for the term group of 101 (48 in the control group and 53 in the experimental group), and for the preterm group of 37 (18 in the control group and 19 in the experimental group). Mother/infants in the standard care group were cared for in the hospital and were discharged using existing hospital discharge criteria. Mother/infants in the experimental group were assessed earlier and discharged home if they met the same criteria. They also were scheduled to receive a minimum of 3 home visits from the community nurses.

Key Findings:
The project leaders identified the following outcomes:

• The experimental group (those with home care) had higher post-discharge costs.
  
• There were no differences in indirect family costs, hospital delivery costs or total system costs.
  
• Babies in the experimental group were more likely to be breast fed on an exclusive basis.
  
• The qualitative data regarding maternal satisfaction appeared to support early discharge from hospital with home visiting by the community nurses.
  
• The results regarding pre-term infants indicated no differences in costs or outcomes between the experimental group and the standard care group. Researchers suggest this may be due in part to a small sample size.

Implications:
The projects leaders indicated that their findings are significant because, in their view:

• The study provides insight into determining the most appropriate site for managing breast feeding problems for term and preterm neonates and may be used to establish evidence for best practice.
  
• The data were collected from a single unit in a large university-affiliated metropolitan health care centre and should therefore be interpreted cautiously. Nevertheless, policy-makers might consider home support for breast feeding as a viable option in terms of costs and clinical outcomes for mothers of term infants.
  
• The study supports offering mothers a choice of standard care, or early discharge with home visits by a lactation consultant or nurse with breast feeding expertise.
  
• The suitability of an early discharge model of care delivery for mothers of preterm infants requires further investigation.

Evaluation Methodology:
A randomized control trial design with prognostic stratification for gestational age at birth was used to study the problem. Eligible mother-infant pairs were stratified as term or preterm and randomly allocated to the experimental or standard care group. Economic and clinical outcomes were measured at study entry at hospital discharge and at a seven-day follow-up session. Both quantitative and qualitative methods for data collection and analysis were employed.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report