Resource implications and budget impact of managing cow milk allergy in the UK

Abstract

Aim: To determine current treatment patterns for infants with cow milk allergy (CMA) and the associated resource implications and budget impact, from the perspective of the UK's National Health Service (NHS).

Methods: A computer-based model was constructed depicting current management of newly-diagnosed infants with CMA derived from patients suffering from this allergy in The Health Improvement Network (THIN) Database. The model spanned a period of 12 months following initial presentation to a general practitioner (GP) and was used to estimate the 12-monthly healthcare cost (at 2006/07 prices) of treating an annual cohort of 18,350 infants from when they initially present to their GP.

Results: Patients presenting with a combination of gastrointestinal and atopic symptoms accounted for 59% of all patients. From the initial GP visit for CMA it took a mean 2.2 months to be put on diet, although treatment varied according to presenting symptoms. A total of 60% of all infants were initially treated with soy, 18% with an extensively hydrolysed formula and 3% with an amino acid formula. A mean 9% of patients remained symptomatic on soy and 29% on an extensively hydrolysed formula. The total cost of managing CMA over the first 12 months following initial presentation to a GP was estimated to be £1,381 per patient and £25.6 million for an annual cohort of 18,350 infants.

Limitations: Patients were not randomised to treatment and resource use was not collected prospectively. Nevertheless, 1,000 eligible patients have been included in the analysis, which should be a sufficiently large sample to accurately assess treatment patterns and healthcare resource use in actual clinical practice. The diagnosis of CMA may not be secure in all cases. Nevertheless, patients were diagnosed as having CMA by a clinician and have been managed by their GP as if they had CMA.

Conclusion: CMA imposes a substantial burden on the NHS. Any strategy that improves healthcare delivery and thereby shortens time to treatment, time to diagnosis and time to symptom resolution should potentially decrease the burden this allergy imposes on the health service and release resources for alternative use.