782 - A Budget Impact Analysis of Expanded Criteria for Pasteurized Donor Human Milk Use: A Single Center Experience

Pasteurized donor human milk (PDHM) is widely used in infants at high risk for necrotizing enterocolitis (NEC). Evidence supports decreased rates of NEC in preterm infants and other populations receiving PDHM when compared to formula. Its widespread use, however, is limited by cost.


Objective: To perform a single center, retrospective chart review and budget impact analysis of expanded eligibility criteria for PDHM in a level IV neonatal intensive care unit and cardiothoracic intensive care unit.

Design/Methods: A cohort of infants in 2019 was identified to be eligible for PDHM under expanded criteria (Table 1). For each diagnosis, an estimated amount of PDHM was calculated based on institutional feeding data from 2019 (56% PDHM and 44% expressed mother’s milk). The number of potential cases of NEC that could have been avoided under the new guidelines were then identified by clinical judgement following chart review. The associated costs for PDHM (San Jose Milk Bank rates) and Stage 2 NEC (Healthcare Cost & Utilization Project rates) were calculated and adjusted to 2022 US dollars. Sensitivity analyses were conducted at varying thresholds of PDHM use and varying numbers of NEC cases prevented to determine the impact on costs.

Results: In 2019, 56 patients received PDHM. Based on the expanded criteria, 268 infants were identified who would be eligible for PDHM (43 preterm/very low birthweight, 138 prostaglandin E1-dependent, 58 hypoxic-ischemic encephalopathy, 54 with GI malformations and NEC). Four cases of medical NEC were identified that potentially could have been prevented under the expanded guidelines. Providing PDHM to the 268 infants who met expanded criteria would have required 11709 oz and cost $52,272 (Table 2). While this represents an additional $36,399 compared to the previous guidelines, cost-savings of $83,007 were realized if one case of NEC was prevented (cost of one case of NEC estimated at $119,405.31), and up to $441,222 if four cases of NEC were prevented.  These trends remained consistent with PDHM intake thresholds of 25% and 75% (Figure).

Conclusion(s):

Expanding PDHM use results in cost-savings from an institutional perspective, despite a small initial upfront cost. Given the long-term sequelae associated with NEC, the total costs saved after discharge and societal impact are likely to be greater, supporting expansion of PDHM guidelines.