Childhood Cow's Milk Allergy Raises Healthcare Costs

Lorraine L. Janeczko, MPH

September 22, 2022

Managing children's cow's milk allergy is costly to families and to healthcare systems, largely owing to costs of prescriptions, according to an industry-sponsored study based on data from the United Kingdom.

"This large cohort study provides novel evidence of a significant health economic burden of cow's milk allergy in children," write lead study author Abbie L. Cawood, PhD, RNutr, MICR, head of scientific affairs at Nutricia Ltd in Trowbridge, and her colleagues write in Clinical and Translational Allergy.

"Management of cow's milk allergy necessitates the exclusion of cow's milk protein from the diet. Whilst breastmilk remains the ideal nutrient source in infants with cow's milk allergy, infants who are not exclusively breastfed require a hypoallergenic formula," add Cawood, also a visiting research fellow at University of Southampton, and her co-authors.

Cow's milk allergy, an immune‐mediated response to one or more proteins in cow's milk, is one of the most common childhood food allergies and affects 2%-5% of infants in Europe. Management involves avoiding cow's milk protein and treating possible related gastrointestinal, skin, respiratory, and other allergic conditions, the authors explain.

In their retrospective matched cohort study, Cawood and her colleagues turned to The Health Improvement Network (THIN), a Cegedim Rx proprietary database of 2.9 million anonymized active patient records. They extracted data from nearly 7000 case records covering 5 years (2015-2020).

They examined medication prescriptions and healthcare professional contacts based on diagnosis read-codes and hypoallergenic formula prescriptions and compared healthcare costs for children with cow's milk allergy with the costs for those without.

They matched 3499 children aged 1 year or younger who had confirmed or suspected cow's milk allergy with the same number of children without cow's milk allergy. Around half of the participants were boys, and the mean observation period was 4.2 years.

Children With Cow's Milk Allergy Need More, Costly Healthcare

The researchers found:

  • Medications were prescribed to significantly more children with cow's milk allergy (CMA), at a higher rate, than to those without CMA. In particular, prescriptions for antireflux medication increased by almost 500%.

  • Children with CMA needed significantly more healthcare contacts and at a higher rate than those without CMA.

  • CMA was linked with additional potential healthcare costs of £1381.53 per person per year. Assuming a 2.5% prevalence from the estimated 2%-5% CMA prevalence range and extrapolating to the UK infant population, CMA may have added more than £25.7 million in annual healthcare costs nationwide.

Kara E. Coffey, MD

"Several conditions in infancy necessitate the elimination of cow milk-based formulas and require extensively hydrolyzed or amino acid formulas or, if preferred or able, exclusive breast milk," Kara E. Coffey, MD, assistant professor of pediatrics at the University of Pittsburgh School of Medicine in Pennsylvania, told Medscape Medical News by email.

"This study shows that, regardless of the reason for cow milk-based avoidance, these infants require more healthcare service utilizations (clinic visits, nutritional assessments, prescriptions) than [do] their peers, which is certainly a commitment of a lot of time and money for their families to ensure their ability to grow and thrive," added Coffey, who was not involved in the study.

Jodi A. Shroba, MSN, APRN, CPNP

Jodi A. Shroba, MSN, APRN, CPNP, the coordinator for the Food Allergy Program at Children's Mercy Kansas City, Missouri, did not find these numbers surprising.

"Children with food allergies typically have other atopic comorbidities that require more visits to primary care physicians and specialists and more prescriptions," Shroba, who also was not involved in the study, said by email.

"An intriguing statement is that the UK guidelines recommend the involvement of a dietitian for children with cow's milk allergy," she noted. "In the US, having a dietitian involved would be a wonderful addition to care, as avoidance of cow's milk can cause nutritional and growth deficiencies. But not all healthcare practices have those resources available.

"The higher rate of antibiotic use and the almost 500% increase of anti-reflux prescriptions by the children with cow's milk allergy warrant additional research," she added.

Nutricia Ltd funded the study. Cawood and one co-author are employed by Nutricia Ltd, and all other co-authors have been employees of or have other financial relationships with Nutricia. One co-author is employed by Cegedim Rx, which was funded for this research by Nutricia. Shroba and Coffey report no conflicts of interest with the study.

Clin Transl Allergy. Published online August 26, 2022. Full text

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