Financial implications Interactive MAP Guideline

CMA imposes a substantial burden on the NHS, as many children with CMA go through months of treatment and often unnecessary investigations before the cause of their symptoms is finally recognised1. The costs of managing CMA can potentially be reduced by ensuring that the best possible care is provided at a primary care level.

It is estimated that 18,350 infants will present to GPs with CMA each year in the UK. The cost of managing these infants over the first 12 months following initial presentation has been estimated to be £25.6 million.

A strategy to reduce the time to diagnosis, and instigate prompt, appropriate management and symptom resolution would potentially decrease this burden on NHS healthcare resources.

As well as improving the clinical management of patients with CMA, the MAP guideline could potentially have positive financial implications at both practice prescribing level, and for Clinical Commissioning Groups.

Factors that contribute to the burden include1:

  • The high number of GP visits (mean 18.2 visits over the first 12 months from initial presentation per patient)
  • The number of GP visits before initiating an appropriate diet (mean 4.2 visits per patient)

The time taken to:

  • prescribe a clinical nutrition preparation (mean 2.2 months after initially seeing a GP)
  • resolve symptoms (mean 2.9 months from the initial GP visit)
  • make a diagnosis (mean 3.6 months from the initial GP visit)

GP visits account for 44% of this 12-monthly cost, while specialised formulas (amino acid formula/extensively hydrolysed formula/soy formula) account for up to 38%, outpatient visits for 9%, and hospital admissions for 6%1.

Potential financial implications of using the MAP Guideline:

By following the Guideline, healthcare professionals can prescribe the most appropriate formula first line. This should reduce the cost of unnecessary prescriptions, which includes prescriptions for formulas which are not likely to be effective.

Timely recognition, diagnosis and management of CMA should mean that fewer prescriptions, if any, are needed for the management of these symptoms in many infants.

By reducing the time to diagnosis, GPs will reduce the number of appointments requested by families of infants with suspected CMA. Managing the condition within primary care (where appropriate) should lead to a reduction in the number of referrals to secondary care. Referrals are often made to several specialised healthcare professionals (e.g. dermatology for eczema, paediatric medicine for reflux and ENT for nasal respiratory symptoms), without the link between the symptoms being made.

The Guideline intends to help healthcare professionals to diagnose and manage infants with suspected cow’s milk allergy quickly and appropriately within primary care. This could potentially reduce the risk of infants requiring A&E visits or inpatient stays, including admissions for troublesome symptoms such as persistent vomiting, choking episodes, difficulty feeding or constipation, which can be associated with cow’s milk allergy. Presentations to secondary care with isolated symptoms may not be recognised as cow’s milk allergy, and GPs seeing infants for a multitude of symptoms are ideally placed to make the association between symptoms and consider CMA.

The Guideline provides clear advice on which investigations may be required and should help to reduce unnecessary examination. Early recognition that the symptoms could be CMA should prevent unnecessary investigations for isolated symptoms (e.g. barium investigations for vomiting, or colonoscopy for diarrhoea).

1. Sladkevicius E, Nagy E, Lack G et al. Resource implications and budget impact of managing cow milk allergy in the UK. J Med Econ 2010;13(1):119-28.