Breastfeeding Could Save Millions in Healthcare Costs

A study spanning 13 years of data in Scotland has estimated that at least £10 million of healthcare costs would have been avoided over the study period if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. The researchers stated that, to their knowledge, this is the first population-level birth cohort study to provide a detailed analysis of the direct cost differences in paediatric healthcare associated with different modes of infant feeding in the UK. 

Half a Million Infants

The data were collected from linked administrative healthcare datasets in a retrospective cohort study of 502,948 singleton infants born in Scotland between 1997 and 2009. 

Bruce Whyte

Corresponding author Bruce Whyte, public health programme manager at the Glasgow Centre for Population Health, told Medscape News UK that although the data was collected several years ago, it should remain generally valid, as the level of breastfeeding in Scotland has not changed significantly in the intervening years. Furthermore, the data provides an interesting new insight into the cost benefits of breastfeeding, in addition to the well-documented direct health benefits. 

The study, published in PLoS ONE, evaluated the cost of GP consultations and hospital admissions for 10 common childhood conditions experienced from birth to 27 months. The results revealed that breastfed infants had better health outcomes, with lower associated healthcare costs, regardless of the level of deprivation in the areas where they lived. 

Among all infants included in the study, 27% were exclusively breastfed, 9% were mixed fed, and 64% were formula fed during the first 6-8 weeks of life. The rates of exclusively breastfed infants ranged from 45% in the least deprived areas to 13% in the most deprived areas. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared with infants fed any formula milk. Specifically, on average, breastfed infants had lower costs of hospital care per admission (£42) compared with formula-fed infants (£79) in the first 6 months of life. Furthermore, they had fewer GP consultations (1.72) than formula-fed infants (1.92). 

The childhood illnesses for which data were monitored were gastrointestinal, respiratory (lower and upper), and urinary tract infections, otitis media, asthma, eczema, diabetes, dental caries, and fevers.

Useful, With Limitations

Prof Ken Ong

"This paper is very useful in quantifying the potential savings in healthcare costs that could be achieved by increasing rates of breastfeeding in Scotland," Ken Ong, a professor at the MRC Epidemiology Unit and Department of Paediatrics at the University of Cambridge, told Medscape News UK. Citing the low rates of breastfeeding in Scotland and the UK more generally, he added: "Improving breastfeeding rates requires not only information and communication about its benefits, but also investments to provide practical instruction and support for new mothers. This paper shows that the return on such investments would be worthwhile."

However, Ong added that "this type of analytical approach does rely on major assumptions and it is likely that the savings are overestimated, as not all of the differences between breastfed and non-breastfed infants are simply due to breast milk. [The authors] do their best to control for area deprivation using valid measures, but even within the same settings, mothers who breastfeed may be more educated and follow other healthier lifestyle choices." But Ong also suggested the potential savings might be underestimated by not including the longer-term benefits of breastfeeding on mothers, such as lower rates of overweight and breast cancer.

Whyte concurred that it was not possible to rule out all possible confounding factors, such as the differences in nutritional and lifestyle behaviours between mothers who choose to breastfeed and those who do not. "But we controlled for a whole range of factors, including ethnicity, parental social class, and so on," he emphasised, adding that probably the greatest strength of the research is that "it isn't modelling… we were looking at the actual cost savings in the cohort".

Although increased healthcare costs were found from the most affluent areas to the most deprived, Whyte pointed out that, "the biggest benefits, potentially, are in the areas where there's lowest levels of breastfeeding, which are the more deprived areas".

While acknowledging that the findings might not be very surprising, the researchers feel they are important to know, and Whyte said that future studies could perhaps lengthen the timescale over which differences were looked for. Future research should investigate the most useful interventions that can support more mothers to breastfeed, he added.

The study was conducted in collaboration with researchers at Public Health Scotland and the University of Glasgow. First author, Omotomilola Ajetunmobi of Public Health Scotland, performed much of the study conceptualisation, design, data curation, investigation, analysis, and validation.

Bruce Whyte and Ken Ong declared no relevant conflicts of interest.