Science You Can Use: Think donor milk is expensive? Wait ’til you see the alternative.

As Neil Patrick Harris declared on a late night talk show a few years ago, pasteurized donor breastmilk doesn’t come cheap.  At the time he was purchasing it directly for his daughter who had some gastrointestinal problems.  “It cost more for breast milk than sushi!” he said.

But “expensive” is of course a relative term.  Donor milk may be more expensive by the ounce than a California roll, and for a (non-celebrity) family whose insurance doesn’t cover it the cost is often prohibitive.

But one would think that, from the perspective of a hospital or insurance company, it’s also a whole lot cheaper than a case of necrotizing enterocolitis (NEC), late onset sepsis, or any number of problems that can arise when preterm infants are exposed to non-human milk products.

This is nicely illustrated by a new study from Rush University Medical Center, home of the famous Rush Mothers’ Milk Club and its pioneering founder Paula Meier, one of the study’s authors.  The investigators  looked at how much money was saved by the avoidance of sepsis when breastmilk was fed to very low birth weight preterm infants in the first 28 days of life.

The authors reported finding that “every 10 milliliters of human milk per kilogram that a very low birth weight infant received during the first 28 days of life decreased the odds of sepsis by almost 20 percent.”

And cost savings?

A daily dose of 25 to 49.99 milliliters of human milk per kilogram cut NICU costs by more than $20,000, while 50 milliliters per kilogram per day lowered NICU costs by nearly $32,000.

Note here that this study considered only sepsis, and not necrotizing enterocolitis, another common, life-threatening, and expensive condition arising from not feeding a preterm infant breastmilk.

To be clear, this study concerned human milk, and not specifically donor milk.  But as we know, many mothers struggle to provide enough milk for their preterm infants, and rely on pasteurized donor milk to meet their infants’ needs.

This reminded me of a presentation I saw at a milk banking conference a few years ago given by neonatologist Dr. Kathie Marinelli, Medical Director of the Mothers’ Milk Bank of New England.  She pointed out that while donor milk might cost $3.00 to $4.50 an ounce, a tiny preemie who is primarily receiving her mother’s own milk may need a supplement of only a few ounces a day.  By one estimate, a baby weighing 2 pounds consumes about 5.5 ounces of milk per day.

How much does it cost to provide the average NICU infant with enough donor milk?  An older study (2002) estimated the cost of donor milk for a “typical” NICU infant, including a bovine-based fortifier, at $1,350 over two months, assuming a cost of $3.00 an ounce.  So if you wanted to be conservative, you could double or even triple that amount to estimate this amount in today’s dollars.

Then, Dr. Marinelli said, compare that to the estimated cost of surgically treating NEC.  About 10% infants weighing less than 3 lbs. 5 oz. experience some form of NEC, and one in seven cases of NEC ends in death.  An exclusively human milk diet reduces the risk of NEC in a preemie by an estimated 77%.

Want to guess her estimate of the cost of surgically treating NEC, which represents the cost over and above the standard cost of NICU care?

Roughly $200,000

And that doesn’t even start to take into account the lifelong medical costs which may follow that episode of NEC, including (to put it bluntly) death, surgical “short gut syndrome,” and a depressed immune system with associated infections.

By one 2001 estimate, if donor milk is as effective as mothers’ own milk, each $1 spent on it would save $11-37 in treatment and length-of-stay costs.  If it’s only half as effective, each dollar would save $6-19.

The growing trend of making donor milk the standard of care in NICUs must owe some of its momentum to these sorts of calculations.  And of course from the ever-clearer fact that not providing donor milk increases the risk of life-threatening diseases and death.

But in this discussion of the economics of breastfeeding and donor milk it’s easy to forget that we are talking about real people and real disease, which involves suffering and sacrifice of many kinds.  The pain and stress experienced by the infant, the emotional distress of the family, the lost time and dashed hopes are but a few of the realities of a life-threatening disease.  And that’s for the infants who survive.  Many don’t.

These are hard to quantify and don’t show up on a balance sheet, but they are real and significant costs.  And these too can often be avoided by the use of breastmilk and donor milk.

Image:  Some of my milk being dropped off at the Mothers’ Milk Bank of New England.

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