Cow’s milk allergy imposes economic burdens on families, on health systems

07 September 2022

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Disclosures:
Cawood reports having held an honorary research post at the University of Southampton and a part-time job with Nutricia Ltd. Please see the study for relevant financial information from all other authors.


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Key points:

  • The drugs were prescribed to significantly more children who had cow’s milk allergy (CMA) and at a higher rate than with children who did not have CMA.
  • Children with vs. without CMA also required a lot more health service contacts that were seen at a higher rate.
  • CMA supported £1,381.53 per person-year in additional health care costs among children with vs. without CMA.

A cow’s milk allergy in infancy is associated with a high economic impact, driven by the necessary prescriptions, according to a study conducted in the UK and published in Clinical and translational allergy.

However, better management approaches can have a positive impact on these costs, Abbie L. White, Ph.D, a visiting researcher at the Institute of Human Nutrition at the University of Southampton and head of scientific affairs at Nutricia AMN UK, and colleagues wrote.


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The retrospective cohort study used data extracted from The Health Improvement Network on November 4, 2020, including data on 3,499 children with a confirmed or suspected cow’s milk allergy (CMA), diagnosed at a mean age of 4.04. months (standard deviation, 2.79), and 3,499 without CMA, all aged 12 months or younger and 54% of whom were male.

Participants were observed for a mean period of 4.2 years (range, 3.5-5.8).

Each child with CMA was prescribed a hypoallergenic formula (HAF) with a mean dose of 122 g per day (± 35.6) for a mean duration of 9.5 months (± 9.1). HAF prescriptions included extensively hydrolyzed formulas (88%) and amino acid formulas (35%).

Infants with CMA had significantly greater use of health care, including drug prescriptions, contacts with health care professionals, and hospital admissions (P. <.001 for all), compared to children who did not have CMA.

Only 1.2% of children with CMA compared with 9% of children who did not have CMA had no prescriptions for antibiotics, anti-reflux drugs, dermatological drugs, inhalers, or adrenaline (P. <.001).

In total, children with CMA experienced a nearly 500% increase in antireflux drug prescriptions, a 95% increase in dermatology drug prescriptions, an 80% increase in inhaler prescriptions, and a 50% increase in antibiotic prescriptions.

These increases in prescription rates are not surprising, the researchers wrote, as other research has found significant increases in rates of gastrointestinal, skin, and respiratory symptoms among children with CMA compared with those without CMA.

The researchers also found that children with CMA had 50 percent more contact with general practitioners, 167 percent more referrals to specialists, and 1,400 percent more contacts with dieticians. Contact rates with dieticians are particularly high, the researchers explained, because current guidelines in the UK recommend that dieters should be involved in the management of ACM.

On a 5-person basis, children with CMA also had significantly higher rates of use of all health care.

In addition to the annual cost of £ 1,559.27 for CMA care, children with CMA incurred £ 7,796.34 in costs over 5 person years. Children who did not have CMA had annual costs per person of £ 177.74 and costs for 5 persons per year of £ 888.70. In addition, the researchers calculated that CMA could represent £ 25.7 million in additional healthcare costs in the UK each year, surpassing £ 128.7 million over 5 years.

Considering the significant health economic burden that CMA presents, the researchers wrote, further studies are needed to investigate clinical phenotypes and management approaches that could impact clinical and health economic outcomes.

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