The document discusses the economic implications of using human milk for very low birth weight (VLBW) infants, emphasizing cost reductions in neonatal intensive care unit (NICU) stays and associated health conditions. It highlights that a lack of mother’s milk and reliance on formula can increase the risk of severe morbidities, thereby escalating healthcare costs. Additionally, it addresses barriers to the initiation and maintenance of lactation, detailing associated costs and potential benefits of providing lactation support in the NICU.

1. The Economics of Human Milk in Very Low Birth
Weight Infants
28 February 2017
Tricia Johnson, PhD
Economist, Rush University Medical Center
Chicago, USA

2. There are many cost implications associated with human milk for
very low birth weight infants
Initial Neonatal Intensive Care Unit
Stay
Reduction in incidence of costly
morbidities and their associated
healthcare costs
- Necrotizing enterocolitis (NEC)
- Late onset sepsis
- Bronchopulmonary dysplasia (BPD)
- Retinopathy of prematurity
- Enteral feeding intolerance
Source: Patel et al. 2012; Schanler et al. 1999; Schanler et al. 2005; Sisk et al. 2007; Sisk et al. 2008; Furman et al. 2003;
Meinzen-Derr et al. 2004; De Silva et al. 2004; Mahon et al, 2016
Infancy and Childhood
Reduction in downstream healthcare
needs associated with NICU
morbidities
Reduction in risk of costly health
conditions and their associated costs
• Leukemia
• Otitis media
• Obesity
• Sudden infant death syndrome

3. LOVE MOM Cohort
3
Longitudinal Outcomes in Very Low Birth Weight Infants
Exposed to Mothers’ Own Milk
- PI: Paula Meier (NIH, NR010009)
- Prospective cohort of 430 VLBW infants born 2008 – 2012
- Infants less than 1500g birth weight
- Primarily minority
- Predominantly low income

4. Morbidities substantially increase cost of NICU hospitalization
4
• Average NICU hospital cost (in 2010 dollars) for
infants with no morbidities: $40,227 ± 16,905
• 39% of infants have 1 morbidity
• 31% of infants have 2 or more morbidities
• Costs increase substantially with each morbidity
• Multiple morbidities may have more than an
additive impact on costs
Source: Johnson et al. 2013

5. Low HM volume in
first 28 days of
life (DOL)
The Mother’s Own Milk – Formula Trade-Off
Supplement with
formula
↑ risk of late-
onset sepsis
5
Supplement with
any formula
↑ risk of NEC
Low HM volume in
first 14 DOL
Supplement with
formula
↑ risk of
bronchopulmonary
dysplasia
Low HM volume
through 36 weeks
GA or discharge
+$41,929
per case
+$43,818
per case
+$10,055
per case
Source: Johnson et al, 2013; Patel et al, 2013; Johnson et al, 2015; Patel et al,

6. Economic Barriers to the Initiation & Maintenance of Lactation
6Source: Meier et al, 2017; costs in 2015 US Dollars
Barrier
Evidence-based materials on HM for preterm infants
Hospital grade electric breast pump rental, 3 months
Pump kit
Custom-fitted breast shields
Hospital-grade HM storage containers
NICU-specific lactation support from NICU-based certified
Breastfeeding Peer Counselors
NICU freezers for safe storage of pumped HM
HM waterless warmers
Liners for waterless warmers
Basic creamatocrit and/or other HM analysis technology to
individualize HM feedings & HM collection strategies
Infant scales for measuring HM intake

7. Economic Barriers to the Initiation & Maintenance of Lactation
7Source: Meier et al, 2017; costs in 2015 US Dollars
Barrier Cost (USD) per Infant
Evidence-based materials on HM for preterm infants $16
Hospital grade electric breast pump rental, 3 months $210
Pump kit $33
Custom-fitted breast shields $7
Hospital-grade HM storage containers $134
NICU-specific lactation support from NICU-based certified
Breastfeeding Peer Counselors
$539
NICU freezers for safe storage of pumped HM $10
HM waterless warmers $50
Liners for waterless warmers $231
Basic creamatocrit and/or other HM analysis technology
to individualize HM feedings & HM collection strategies
$1
Infant scales for measuring HM intake $6

8. Costs versus Benefits of Human Milk Provision for VLBW Infants in
the NICU
8
+$1,238
Cost of providing support
for lactation initiation
and maintenance
Benefit to infant in NICU
ê NEC
ê Sepsis
ê BPD
Source: Johnson et al, 2013; Patel et al, 2013; Johnson et al, 2015; Patel et al, 2016; Meier et al, 2017

9. Contact Information
9
Tricia Johnson, PhD
Rush University Medical Center
Department of Health Systems Management
1700 West Van Buren Street
Chicago, IL 60612
Tricia_J_Johnson@rush.edu
+1 312 942 7107