Probiotics: are they cost effective?

Like almost any intervention in the NICU (even maternal breast milk requires pumps and equipment, and kangaroo care requires chairs) there is some cost associated with routine probiotic administration. A new publication attempts to calculate the cost-effectiveness relationship. (Craighead AF, et al. Cost-effectiveness of probiotics for necrotizing enterocolitis prevention in very low birth weight infants. J Perinatol. 2020).

They used baseline estimates of NEC incidence of 5.8%, reduced to 2.4% by probiotics, costs of NEC hospitalisations and rates of serious long term outcomes and their costs from the literature. The baseline cost of the probiotics they included was $2,200 per baby.

Using these estimates, routine use of probiotics in at-risk babies (with that baseline NEC risk) cost $1,868 per QALY (quality-adjusted life-year) saved. Which is probably the most cost-effective intervention ever seen in an ICU!

When you perform a study like this you start with baseline assumptions and then see how variations of those assumptions affect the calculations.

If your region has more NEC than 5.8% then the costs per QALY are even lower. In fact, they showed that at a NEC incidence above 6.5% probiotics don’t cost anything, they start to have a negative cost, the the system as a whole saves money by instituting routine probiotics.

Even at a NEC incidence of 2% probiotics only cost about $18,000 per QALY, which is dramatically below the threshold used to fund new interventions in the UK (about $100,000).

If your probiotics cost less than $2200 per baby then again the calculations are changed. Our probiotics currently cost 50 cents a day per baby (single-use sachets of Florababy). I haven’t calculated the average cost per baby, but a 24-week infant receives them for 10 weeks, or $35. If you don’t change any other assumptions then the total cost per QALY is -$5000! At that low a cost, probiotics are cost-effective at a NEC incidence of 0.1% (a figure I just made up, the real threshold may be much lower than that).

The results of this analysis are hardly a surprise, probiotics are currently relatively inexpensive to use in the NICU and prevent a serious condition, here’s hoping that they stay that way.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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