The health economic impact of cow's milk allergy in childhood: A retrospective cohort study

Abstract

Background: Cow's milk allergy (CMA) is one of the most common food allergies among children. Whilst avoidance of cow's milk protein is the cornerstone of management, further treatment of symptoms including those affecting the gastrointestinal, skin and respiratory systems plus other allergic comorbidities, maybe required. This study aimed to quantify the wider economic impact of CMA and its management in the United Kingdom (UK). Methods:We conducted a retrospective matched cohort study on children with CMA (diagnosis read code and/or hypoallergenic formula prescription for ≥3 months) examining healthcare data (medication prescriptions and healthcare professional contacts) from case records within The Health Improvement Network (A Cegedim Proprietary Database) in the UK. A comparative cost analysis was calculated based on healthcare tariff and unit costs in the UK.Results: 6998 children (54% male; mean observation period 4.2 years) were included (n = 3499 with CMA, mean age at diagnosis 4.04 months; n = 3499 matched controls without CMA). Compared to those without CMA, medications were prescribed to significantly more children with CMA (p < 0.001) at a higher rate (p < 0.001). Children with CMA also required significantly more healthcare contacts (p < 0.001) at higher rate (p < 0.001) compared to those without CMA. CMA was associated with additional potential healthcare costs of £1381.53 per person per year. Conclusion:The findings of this large cohort study suggest that CMA and its associated co-morbidities presents a significant additional healthcare burden with economic impact due to higher prescribing of additional medications. Further research into management approaches that may impact these clinical and economic outcomes of CMA is warranted.

Impact of a dietitian in general practice: paediatric food allergy

“…A cost‐effectiveness analysis of the two models was beyond the scope of this project but would be valuable to understand the costs of delivering the services, any cost savings and improvements in outcomes for patients. A recent paper, however, has described the increased health economic impact of CMA in childhood, 41 for which our findings may provide some solutions. One obvious difference between the models is the availability of group sessions in dietetic community care, which could result in some cost savings assuming most patients do not subsequently require individual support.…”

A review of food allergy-related costs with consideration to clinical and demographic factors

“…Results from the current review suggest that food allergy accounts for a relatively modest proportion of the total healthcare spending of western countries but is a significant cost contributor nevertheless [3 ▪ ,8,10 ▪ ,13]. Much of the cost of food allergy stems from routine allergy care, but a sizeable proportion can also be attributed to emergency room visits and hospitalizations [3 ▪ ,8,12 ▪ ,13].…”

“…European and American studies have demonstrated, however, that individuals with food allergy incur greater direct healthcare costs relative to comparison groups constituted of both individuals without a food allergy and those without a specific allergy of interest (e.g. peanut allergy) [10 ▪ ,11,12 ▪ ,13,14]. Similar to the total direct costs, estimates of the additional or incremental healthcare costs incurred by individuals with food allergy vary across studies, ranging from +$465.06 per person per year (i.e.…”

“…Similar to the total direct costs, estimates of the additional or incremental healthcare costs incurred by individuals with food allergy vary across studies, ranging from +$465.06 per person per year (i.e. PPY) to +$3698.20 PPY, depending on the study design, location, and allergens studied [10 ▪ ,11,12 ▪ ,13,14]. Recently, Hua et al [15 ▪ ] extended these findings by providing evidence that Australian children with food allergy also accrue greater direct healthcare costs.…”

Pilot Study of the Applicability, Usability, and Accuracy of the Nutricate© Online Application, a New Dietary Intake Assessment Tool for Managing Infant Cow’s Milk Allergy

“…Consequently, the patient is most often referred to a hospital dietician or an allergy clinic [ 10 ]. Cow’s milk allergy management has an economic impact that generates an increase in health costs due to the duplication in medical consultation between the PCP, the hospital [ 12 ], and the other health services, such as specialized nutrition [ 13 ]. Several studies have highlighted the clinical [ 14 ], population-level [ 15 ], and economic burden of cow’s milk allergy [ 11 ].…”