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Substudy 12 Fact Sheet
Cost Effectiveness of Home Versus Hospital Support of Breast Feeding
in Neonates (NA101-12)
University of Toronto
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.
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
The project leaders identified the following outcomes:
- The experimental group (those with home care) had higher post-discharge
- 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
- 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
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.
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
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: