Suboptimal breastfeeding leads to excess costs, deaths

A comprehensive pediatric cost analysis found that suboptimal breastfeeding levels result in billions of dollars in excess costs and hundreds of preventable infant deaths. In updating a similar 2001 study conducted by the Agency for Healthcare Research and Quality (AHRQ), investigators used the risk ratios from a comprehensive analysis of the evidence for the effect of breastfeeding on a variety of diseases of children and mothers, as well as relatively recent data on breastfeeding rates, disease incidence, and costs. The study analyzed all the diseases in offspring for which the AHRQ report found a risk reduction with any or exclusive breastfeeding: necrotizing enterocolitis (NEC), otitis media, gastroenteritis, hospitalization for lower respiratory tract infections (LRTI) during infancy, atopic dermatitis, sudden infant death syndrome (SIDS), childhood leukemia, childhood asthma, obesity, and type 1 diabetes (type 2 diabetes was excluded because of insufficient data).

Investigators calculated the differential incidence of disease in breastfed and nonbreastfed infants and the associated costs at 2005 rates of breastfeeding compared with the rates specified in Healthy People 2010 goals and 80% and 90% compliance with medical recommendations. Cost impact was determined by subtracting projected costs from 2007 costs. Direct and indirect costs for each disease were included, along with the cost of death during childhood from NEC, SIDS, childhood asthma, childhood leukemia, LRTI, and type 1 diabetes.

The analysis showed that if 90% of US families complied with medical recommendations to breastfeed exclusively for 6 months, the savings could amount to $13 billion a year, and an excess of 911 deaths could be prevented annually, 95% of whom would be infants. With 80% compliance, $10.5 billion would be saved and 741 deaths prevented. Meeting the Healthy People 2010 goals would result in savings of $2.2 billion and 142 prevented deaths (Bartick M, et al. Pediatrics. 2010;125[5]:e1048-e1056).

We have a long way to go to get to 80% and 90% compliance with the recommendation for exclusive breastfeeding for 6 months. In 2005, 12.3% of families met this goal. The Healthy People 2010 goal was 17%, and the authors estimate that meeting even that modest figure would result in savings of $2.2 billion dollars and 142 lives. To advance further, we'll need to explain clearly to new mothers how breastfeeding benefits their babies. Maybe, to increase incentives to breastfeed, we should devise a mechanism for sharing some of these cost savings with mothers, perhaps with extended maternity leave or cash. -MB