Childhood Cow’s Milk Allergy Raises Healthcare Costs

Managing children’s cow’s milk allergy is costly to families and healthcare systems, largely due to the cost of prescriptions, according to an industry-funded study based on UK data.

“This large cohort study provides new evidence of a significant health economic burden of cow’s milk allergy in children,” write the study’s lead author, Abbie L. Cawood, PhD, RN, MICR, Head of Scientific Affairs at Nutricia Ltd in Trowbridge, and her colleagues Clinical and translational allergy.

“Management of cow’s milk allergy requires the elimination of cow’s milk protein from the diet. While breast milk remains the ideal nutrient source for infants with cow’s milk allergy, non-exclusively breastfed infants require a hypoallergenic formula,” adds Cawood, also a Visiting Research Fellow at the University of Southampton, and her co-authors.

Mild cow allergy, an immune-mediated reaction to one or more proteins in cow’s milk, is one of the most common childhood food allergies, affecting 2–5% of infants in Europe. Management includes avoiding cow’s milk protein and treating possible associated 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 proprietary Cegedim Rx database of 2.9 million anonymized active patient records. They extracted data from almost 7000 case records over 5 years (2015-2020).

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They examined drug prescriptions and healthcare professional contacts based on diagnostic read codes and hypoallergenic formula prescriptions, and compared the healthcare costs for children with cow’s milk allergy to those for children without cow’s milk allergy.

They compared 3,499 children aged 1 year or younger who had a confirmed or suspected cow’s milk allergy with the same number of children without a cow’s milk allergy. About half of the participants were boys, the mean observation period was 4.2 years.

Children with cow’s milk allergy require more expensive health care

The researchers found:

  • Children with cow’s milk allergy (CMA) were prescribed medication significantly more often than children without CMA. In particular, antireflux drug prescriptions increased by almost 500%.

  • Children with CMA required significantly more and more frequent health contacts than children without CMA.

  • CMA had an additional potential healthcare cost of £1381.53 per person per year. Taking a prevalence of 2.5% from the estimated 2% to 5% CMA prevalence range and extrapolating to the UK infant population, CMA could have added more than £25.7 million in annual healthcare costs nationwide.

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Kara E. Coffey, MD

“Some disorders in infancy require the elimination of cow’s milk-based formulas and require highly hydrolyzed or amino acid formulas or, if preferred or possible, exclusively human milk,” Kara E. Coffey, MD, assistant professor of pediatrics at the University of Pittsburgh School of Medicine in Pennsylvania, narrated Medscape Medical News by email.

“This study shows that regardless of the reason for avoiding cow’s milk, these infants seek more health services (clinic visits, nutritional assessments, prescriptions) than [do] their peers, which certainly means a lot of time and money for their families to make sure they can grow and thrive,” added Coffey, who was not involved with the study.

Jodi A Shroba, MSN, APRN, CPNP

Jodi A. Shroba, MSN, APRN, CPNP, the food allergy program coordinator at Children’s Mercy Kansas City, Missouri, didn’t find these numbers surprising.

“Children with food allergies typically have other atopic comorbidities that require more GP and specialist visits and more prescriptions,” Shroba, who was also not involved with the study, said via email.

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“One intriguing statement is that UK guidelines recommend the involvement of a dietitian for children with cow’s milk allergy,” she noted. “In the US, the involvement of a nutritionist would be a wonderful addition to care, as avoiding cow’s milk can lead to nutritional and growth deficiencies. But not all healthcare practices have these resources.

“The higher rate of antibiotic use and the nearly 500 percent increase in antireflux prescriptions by children with cow’s milk allergy warrant additional research,” she added.

Nutricia Ltd funded the study. Cawood and a co-author are with Nutricia Ltd. and all other co-authors were Nutricia employees or have other financial ties to Nutricia. A co-author is employed by Cegedim Rx, which was funded by Nutricia for this research. Shroba and Coffey report no conflicts of interest related to the study.

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

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