OBJECTIVES: Evidence demonstrates significant clinical benefits associated with PDHM (pasteurized donor human milk) provision when mother’s own milk is unavailable/inadequate to meet her very low birthweight (VLBW) neonate’s needs (birthweight <1500g). Necrotizing enterocolitis (NEC), a complication attributed to prematurity, is preventable through the provision of PDHM. Our model is a tool designed to evaluate potential savings to Medicaid programs under a PDHM reimbursement policy.

METHODS: We created a decision tree model from the Georgia Medicaid perspective to study the budget impact of PDHM reimbursement. VLBW neonates developed NEC stage I or II+ at rates from published data from the Donor Milk for Improved Neurodevelopmental Outcomes (DoMINO) RCT (ISRCTN35317141). For initial hospitalization costs, we used 2010-2017 data from the GA Department of Community Health. We identified NEC using ICD-9 (777.5, 775.50-777.53) and ICD-10 codes (P77.1-77.3, P77.9, K55.30-55.33). We took milk and three-year follow-up costs from the medical literature. As a robustness check, we conducted univariate deterministic (DSA) and multivariate probabilistic sensitivity analyses (PSA).

RESULTS: For an expected one-year population of VLBW newborns requiring intervention in GA (n=685), inclusion policy results in total discounted cost-savings of $6.10MM ($8,905 per-patient) over three years (2017 USD). In DSA, cost-savings were most sensitive to 6/12-month medical NEC costs; varying this parameter between $0-$155,594 resulted in a range of total cost-savings between $4.94MM-$15.45MM. In PSA (10,000 Monte Carlo iterations), the PDHM policy was cost-saving 90.2%, 89.2%, and 88.5% of the time over 12, 24, and 36 months, respectively.

CONCLUSIONS: PDHM reimbursement for treatment of VLBW neonates is likely to be cost-saving from the GA-state Medicaid perspective. Additional studies are needed to quantify humanistic benefits including improved health-related quality of life (HR-QoL) and indirect cost-savings. In addition to cost-savings, the inclusion of PDHM into Medicaid addresses social determinants of health currently affecting outcomes of the VLBW population.