title: The economic benefits of increasing kangaroo skin-to-skin care and breastfeeding in neonatal units: analysis of a pragmatic intervention in clinical practice.
abstract: BACKGROUND
  A number of significant recent research studies have used techniques of economic modelling to demonstrate the potential benefits of increasing breastfeeding rates in the UK overall, and specifically in neonatal care. This paper complements this growing body of evidence by presenting an economic analysis of data from an actual intervention, the 'Getting It Right From the Start' programme, which took place in the north of the UK during 2011-12, with the aim of increasing breastfeeding and kangaroo skin-to-skin care rates in neonatal units.
  
  
  METHODS
  'Getting It Right from the Start' was a pragmatic, multifaceted programme of change delivered under the auspices of the regional Health Innovation and Education Cluster, of which 17 were established in the UK in 2010. It engaged with 18 neonatal units in two Neonatal Networks with the aim of increasing kangaroo skin-to-skin care and breastfeeding rates. As part of the evaluation of the programme, we conducted an economic study comparing the overall costs and benefits of the intervention.
  
  
  RESULTS
  Overall, the economic analysis demonstrated that for every £1 invested in the intervention to increase kangaroo skin-to-skin care and breastfeeding rates, between £4.00 and £13.82 of benefit was generated. This was spread across different healthcare settings and the timescale for the realisation of benefits will vary. The increases in kangaroo skin-to-skin care generated the greatest cost savings, with potential cost savings ranging between £668,000 (minimum cost assumptions) to more than £2 m (maximum cost assumptions). Increases in breastfeeding associated with the project generated between £68,486 and £582,432. The majority of the cost savings generated were associated with reductions in cases of gastroenteritis and necrotising enterocolitis.
  
  
  CONCLUSIONS
  This was one of the first economic evaluations of an actual intervention to increase breastfeeding and kangaroo skin-to-skin care in neonatal units. It complements the existing economic models by demonstrating that a real intervention in clinical practice was both cost effective as well as clinically beneficial. Future interventions with similar methodology should be supported and considered likely to generate significant cost savings compared to outlay. Economic evaluation should be more frequently included in studies of practical interventions in clinical settings to increase breastfeeding.
authors.affiliation: York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ UK.
authors.forename: Karin
authors.initials: K
authors.lastname: Lowson
authors.affiliation: Specialty Registrar in Public Health, University of York, Heslington, York, North Yorkshire YO10 5NH UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Offer
authors.affiliation: Department of Nursing and Midwifery, Faculty of Health and Wellbeing, Sheffield Hallam University, Robert Winston Building (F414), Collegiate Crescent Campus, Sheffield, South Yorkshire S10 2BP UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Watson
authors.affiliation: Hull York Medical School/NIHR Centre for Reviews and Dissemination, University of York, Heslington, York, North Yorkshire YO10 5NH UK.
authors.forename: Bill
authors.initials: B
authors.lastname: McGuire
authors.affiliation: University of Dundee, School of Nursing & Midwifery, 11 Airlie Place, Dundee, DD1 4HJ UK.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Renfrew
keywords: Benefits; Breastfeeding; Change at scale; Costs; Economics; Kangaroo care; Kangaroo skin-to-skin; Neonatal; Preterm; Quality improvement; Skin-to-skin