title: Economics of home vs. hospital breastfeeding support for newborns.
abstract: OBJECTIVE
  This paper presents the findings of research comparing the incremental costs associated with the provision of home-based vs. hospital-based support for breastfeeding by nurse lactation consultants for term and near-term neonates during the first week of life.
  
  
  BACKGROUND
  A consequence of both consumer demands and increasing health resource constraints is that alternative care delivery models for safe, efficacious and cost-effective breastfeeding programmes have steadily evolved. To date, the economic impact of the setting (home or hospital) where lactation support is delivered has received little research attention.
  
  
  METHODS
  Mother-infant dyads were stratified by gestational age as term (>37 weeks gestational age; n = 101) or near term (35-37 weeks gestational age; n = 37) and randomized to standard hospital care and postpartum follow-up (standard care), or to standard hospital care plus home support from certified nurse lactation consultants (experimental). Data collection occurred at study entry, hospital discharge and at a seventh day postpartum follow-up session. Costs to the family (out-of-pocket and time costs) and to the healthcare system (during hospitalization and after hospital discharge) were measured. Total societal costs were defined as the sum of both family and healthcare system costs.
  
  
  RESULTS
  Compared with standard hospital-based care, home support by nurse lactation consultants showed no statistically significant differences in either time costs to the family or total societal costs. Term infants who received home support had statistically significantly greater postdischarge system costs (P < 0.0001), with a trend towards lower out-of-pocket expenses to their families (P = 0.12). There were no statistically significant differences between the two groups in overall combined family and healthcare system costs.
  
  
  CONCLUSIONS
  These results suggest that the cost of home lactation support programmes were comparable with the costs of hospital-based standard care. Breastfeeding support at home by lactation consultants should be considered as an option as it was no more costly than support from lactation consultants in the hospital setting. The findings for near-term infants need to be interpreted with caution, given the small sample size.
authors.affiliation: Faculties of Nursing and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. b.stevens@utoronto.ca
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Denise
authors.initials: D
authors.lastname: Guerriere
authors.forename: Patricia
authors.initials: P
authors.lastname: McKeever
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.forename: Karen-Lee
authors.initials: KL
authors.lastname: Miller
authors.forename: Jo
authors.initials: J
authors.lastname: Watson-MacDonell
authors.forename: Sharyn
authors.initials: S
authors.lastname: Gibbins
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
authors.forename: Karen
authors.initials: K
authors.lastname: Ray
authors.forename: Peter
authors.initials: P
authors.lastname: Coyte
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003152:Community Health Nursing / Q000191:economics; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D017283:Neonatal Nursing / Q000191:economics / Q000458:organization & administration*; D009721:Nurse Midwives / Q000191:economics; D015401:Nursing Administration Research; D011181:Postnatal Care / Q000191:economics* / Q000458:organization & administration