dc.contributor.author | Anokye, N | en_US |
dc.contributor.author | Coyle, K | en_US |
dc.contributor.author | Relton, C | en_US |
dc.contributor.author | Walters, S | en_US |
dc.contributor.author | Strong, M | en_US |
dc.contributor.author | Fox-Rushby, J | en_US |
dc.date.accessioned | 2020-01-07T10:41:10Z | |
dc.date.available | 2019-08-02 | en_US |
dc.date.issued | 2020-02 | en_US |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/62226 | |
dc.description.abstract | OBJECTIVE: To provide the first estimate of the cost-effectiveness of financial incentive for breastfeeding intervention compared with usual care. DESIGN: Within-cluster ('ward'-level) randomised controlled trial cost-effectiveness analysis (trial registration number ISRCTN44898617). SETTING: Five local authority districts in the North of England. PARTICIPANTS: 5398 mother-infant dyads (intervention arm), 4612 mother-infant dyads (control arm). INTERVENTIONS: Offering a financial incentive (over a 6-month period) on breast feeding to women living in areas with low breastfeeding prevalence (<40% at 6-8 weeks). MAIN OUTCOME MEASURES: Babies breast fed (receiving breastmilk) at 6-8 weeks, and cost per additional baby breast fed. METHODS: Costs were compared with differences in area-level data on babies' breast fed in order to estimate a cost per additional baby breast fed and the quality-adjusted life year (QALY) gains required over the lifetime of babies to justify intervention cost. RESULTS: In the trial, the total cost of providing the intervention in 46 wards was £462 600, with an average cost per ward of £9989 and per baby of £91. At follow-up, area-level breastfeeding prevalence at 6-8 weeks was 31.7% (95% CI 29.4 to 34.0) in control areas and 37.9% (95% CI 35.0 to 40.8) in intervention areas. The adjusted difference between intervention and control was 5.7 percentage points (95% CI 2.7 to 8.6; p<0.001), resulting in 10 (95% CI 6 to 14) more additional babies breast fed in the intervention wards (39 vs 29). The cost per additional baby breast fed at 6-8 weeks was £974. At a cost per QALY threshold of £20 000 (recommended in England), an additional breastfed baby would need to show a QALY gain of 0.05 over their lifetime to justify the intervention cost. If decision makers are willing to pay £974 (or more) per additional baby breast fed at a QALY gain of 0.05, then this intervention could be cost-effective. Results were robust to sensitivity analyses. CONCLUSION: This study provides information to help inform public health guidance on breast feeding. To make the economic case unequivocal, evidence on the varied and long-term health benefits of breast feeding to both the baby and mother and the effectiveness of financial incentives for breastfeeding beyond 6-8 weeks is required. | en_US |
dc.format.extent | 155 - 159 | en_US |
dc.language | eng | en_US |
dc.language.iso | en | en_US |
dc.relation.ispartof | Arch Dis Child | en_US |
dc.rights | Creative Commons Attribution 4.0 Unported (CC BY 4.0) license | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | |
dc.subject | Health Economics | en_US |
dc.subject | RCT | en_US |
dc.subject | breast feeding | en_US |
dc.subject | cost-effectiveness | en_US |
dc.subject | financial incentive | en_US |
dc.title | Cost-effectiveness of offering an area-level financial incentive on breast feeding: a within-cluster randomised controlled trial analysis. | en_US |
dc.type | Article | |
dc.rights.holder | © Author(s) (or their employer(s)) 2019. | |
dc.identifier.doi | 10.1136/archdischild-2018-316741 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/31444210 | en_US |
pubs.issue | 2 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 105 | en_US |
dcterms.dateAccepted | 2019-08-02 | en_US |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | Default project | en_US |