This is the first study to estimate the initial maternal cost of providing 100
mL of HM for VLBW infants and included only the required components that all mothers need to provide their HM: The BPRF, the BPCK, and the maternal time. The findings from this study suggest that institutions and payers may actually realize a cost savings by reimbursing costs for the BPRF and the BPCK. Our data reveal that the cost of HM from the infant's own mother ($0.95–$1.55) is less expensive than donor milk ($13.59), specialty formula ($1.06), and ready-to-feed formula ($2.97) that are commonly used in the NICU for this population.
This analysis also demonstrated that the cost per 100
mL of HM declined with each additional day of pumping (). This cost reduction is a predictable outcome because maternal milk output increases significantly during the early post-birth period29
without an increase in pumping time or fixed costs. The increasing daily milk output rapidly mitigates the initial costs of providing milk, with a low mean cost per 100
mL of $1.03 on study day 22. Although not examined in this study, the cost per 100
mL in the second month post-birth would likely be lower because the fixed cost of the BPCK is removed and milk output should remain stable or increase.29
Removing the cost of the BPCK in month 1 supports this speculation because the mean cost per 100
mL of HM decreases to $0.36 (). These findings suggest a return on investment for the BPRF and BPCK cost during the first weeks of pumping. Moreover, this trend suggests that the return on investment would remain stable or potentially increase with additional months of pumping. This trend also suggests that HM from the infants' own mother is less expensive than donor milk and commercial formula over the entire NICU stay.
These findings have important implications for clinical practice and health policy. To initiate lactation for a VLBW infant, mothers must pay between $90 and $150 for the first month's BPRF and the purchase of the BPCK. Most payers and institutions do not reimburse or pay these costs, so they are borne by the mothers.20–24
This initial cost can be prohibitive because preterm birth means other unexpected expenses (e.g., increased insurance co-payments, hospital parking fees, lost wages). Programs that provide the BPRF and BPCK to mothers have reported high rates of HM feedings, even among low-income families.19,20,22
These successes dispel the myth that mothers do not initiate lactation because they are disinterested or unmotivated.20,22
Rather, the success of these programs implies that mothers will provide their milk when the cost barriers associated with lactation for a VLBW infant are removed or reduced.
In this analysis, MOC was the largest overall contributor to the cost of providing 100
mL of HM, and removing this cost substantially reduced the cost per 100
mL (). This finding raises the fundamental question of how MOC should be treated in economic analyses of breastfeeding or providing HM. From an economic perspective, opportunity cost is a standard measure in cost analyses because it captures the value of a person's time when she or he chooses one activity, such as pumping, over other activities, such as paid work or leisure time.
In economic analyses of breastfeeding or providing HM, it can be argued that MOC should be excluded from cost analyses because most mothers are not medically eligible to return to paid work during the first weeks post-birth. However, other experts contend that including the value of maternal time allows society to examine the economic contribution that mothers make when they choose to breastfeed or provide HM.30
Because both arguments are legitimate, we have chosen to report the cost of providing 100
mL of HM with and without MOC, an approach that seems pragmatic for subsequent economic studies of breastfeeding and providing HM.
Finally, this study examines the initial maternal cost of providing HM and only analyzed the costs for items that are universally required by all mothers of VLBW infants to initiate HM feeding, including the BPRF, the BPCK, and maternal time. This study is a necessary first step in determining the cost of HM feedings because if a mother does not initiate pumping, then other potential HM-associated costs, including other maternal and institutional costs,19,20
are not relevant. Future analyses should examine additional potential sources of maternal cost (e.g., breastfeeding bras, pads, creams, pillows, additional dietary needs, prescription pharmaceuticals) and institutional costs (e.g., HM storage containers, lactation specialist care, hospital freezer space) that are associated with HM feeding.19,20