Abstract：
Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK.
A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion.
The incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16-26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40-£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35-40%.
Available breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.
A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion.
The incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16-26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40-£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35-40%.
Available breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.
摘要：
母乳喂养与母亲和婴儿的健康益处以及卫生服务的成本节约有关。由于各种原因，包括文化障碍，英国的母乳喂养率很低，对启动和维持母乳喂养的支持不足，缺乏信息,或者选择不母乳喂养。已经制定了旨在提高母乳喂养率的教育和支持干预措施。这项研究的目的是评估这种干预措施对妇女的成本效益，在产前或出生后的前8周内开始，旨在提高母乳喂养率，在英国。
从英格兰健康和个人社会服务的角度，构建了一个决策分析模型，以比较母乳喂养干预措施的成本和质量调整寿命年（QALYs）。干预效果和母乳喂养益处的数据来自系统评价。其他模型输入参数是从公开来源获得的，补充专家意见。
标准护理与标准护理相比，模型干预措施的增量成本效益比（ICER）为51,946英镑/QALY，这表明，根据英国国家健康与护理卓越研究所(NICE)的标准，该干预措施不具成本效益。敏感性分析表明，干预措施的成本效果随着干预效果的提高和干预成本的降低而提高。在基本情况下（出生后16-26周母乳喂养率增加19％），如果每位接受干预的女性的成本为≈40-45英镑,则干预是具有成本效益的(<20,000英镑/QALY).按基本情况计算（84英镑），如果该干预措施使母乳喂养率至少提高35-40%,则具有成本效益.
在英国，根据NICE标准，现有的母乳喂养干预措施似乎没有成本效益。与目前可用的干预措施相比，未来的母乳喂养干预措施需要具有更高的有效性或更低的成本，以便具有成本效益。公共卫生和其他社会干预措施，促进和支持母乳喂养可能是提高英国母乳喂养率的关键.
从英格兰健康和个人社会服务的角度，构建了一个决策分析模型，以比较母乳喂养干预措施的成本和质量调整寿命年（QALYs）。干预效果和母乳喂养益处的数据来自系统评价。其他模型输入参数是从公开来源获得的，补充专家意见。
标准护理与标准护理相比，模型干预措施的增量成本效益比（ICER）为51,946英镑/QALY，这表明，根据英国国家健康与护理卓越研究所(NICE)的标准，该干预措施不具成本效益。敏感性分析表明，干预措施的成本效果随着干预效果的提高和干预成本的降低而提高。在基本情况下（出生后16-26周母乳喂养率增加19％），如果每位接受干预的女性的成本为≈40-45英镑,则干预是具有成本效益的(<20,000英镑/QALY).按基本情况计算（84英镑），如果该干预措施使母乳喂养率至少提高35-40%,则具有成本效益.
在英国，根据NICE标准，现有的母乳喂养干预措施似乎没有成本效益。与目前可用的干预措施相比，未来的母乳喂养干预措施需要具有更高的有效性或更低的成本，以便具有成本效益。公共卫生和其他社会干预措施，促进和支持母乳喂养可能是提高英国母乳喂养率的关键.
