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

Key takeaways:

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

An allergy to cow’s milk during childhood is associated with a high economic impact, driven by necessary prescriptions, according to a study conducted in the United Kingdom and published in Clinical and Translational Allergy.

However, improved management approaches may have a positive impact on these costs, Abbie L. Cawood, PhD, a visiting research fellow with the Institute of Human Nutrition at the University of Southampton and head of scientific affairs at Nutricia AMN UK, and colleagues wrote.

The retrospective cohort study used data extracted from The Health Improvement Network on Nov. 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).

Every infant 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 more health care usage, including medication prescriptions, health care professional contacts and hospital admissions (P < .001 for all), than infants who did not have CMA.

Only 1.2% of the infants with CMA compared with 9% of the infants who did not have CMA did not have prescriptions for antibiotics, anti-reflux medications, dermatological medication, inhalers or adrenaline (P < .001).

In total, infants with CMA experienced a nearly 500% increase in anti-reflux medication prescriptions, a 95% increase in dermatological medication 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 significantly increased rates of gastrointestinal, skin and respiratory symptoms among children with CMA compared with those who do not have CMA.

The researchers further found that infants with CMA had 50% more contacts with general practitioners, 167% more referrals to specialists and 1,400% more contacts with dietitians. The rates of contacts with dietitians are particularly high, the researchers explained, because current guidelines in the United Kingdom recommend that dietitians should be involved in managing CMA.

Based on 5 person-years, children with CMA also had significantly higher rates of all health care usage.

In addition to the per-year 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 single person-year costs of £177.74 and 5 person-year costs of £888.70. Further, the researchers calculated that CMA could account for £25.7 million in additional health care costs in the U.K. each year, exceeding £128.7 million over 5 years.

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