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. CONCLUSION: 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.
ABSTRACT
On palaeoclimate time scales, enhanced levels of geological and geomorphological activity have been linked to climatic factors, including examples of processes that are expected to be important in current and future anthropogenic climate change. Planetary warming leading to increased rainfall, ice-mass loss and rising sea levels is potentially relevant to geospheric responses in many geologically diverse regions. Anthropogenic climate change, therefore, has the potential to alter the risk of geological and geomorphological hazards through the twenty-first century and beyond. Here, we review climate change projections from both global and regional climate models in the context of geohazards. In assessing the potential for geospheric responses to climate change, it appears prudent to consider regional levels of warming of 2 degrees C above average pre-industrial temperature as being potentially unavoidable as an influence on processes requiring a human adaptation response within this century. At the other end of the scale when considering changes that could be avoided by reduction of emissions, scenarios of unmitigated warming exceeding 4 degrees C in the global average include much greater local warming in some regions. However, considerable further work is required to better understand the uncertainties associated with these projections, uncertainties inherent not only in the climate modelling but also in the linkages between climate change and geospheric responses.
