title: Cost analysis of maternal disease associated with suboptimal breastfeeding.
abstract: OBJECTIVE
  To estimate the U.S. maternal health burden from current breastfeeding rates both in terms of premature death as well as economic costs.
  
  
  METHODS
  Using literature on associations between lactation and maternal health, we modeled the health outcomes and costs expected for a U.S. cohort of 15-year-old females followed to age 70 years. In 2002, this cohort included 1.88 million individuals. Using Monte Carlo simulations, we compared the outcomes expected if 90% of mothers were able to breastfeed for at least 1 year after each birth with outcomes under the current 1-year breastfeeding rate of 23%. We modeled cases of breast cancer, premenopausal ovarian cancer, hypertension, type 2 diabetes mellitus, and myocardial infarction considering direct costs, indirect costs, and cost of premature death (before age 70 years) expressed in 2011 dollars.
  
  
  RESULTS
  If observed associations between breastfeeding duration and maternal health are causal, we estimate that current breastfeeding rates result in 4,981 excess cases of breast cancer, 53,847 cases of hypertension, and 13,946 cases of myocardial infarction compared with a cohort of 1.88 million U.S. women who optimally breastfed. Using a 3% discount rate, suboptimal breastfeeding incurs a total of $17.4 billion in cost to society resulting from premature death (95% confidence interval [CI] $4.38-24.68 billion), $733.7 million in direct costs (95% CI $612.9-859.7 million), and $126.1 million indirect morbidity costs (95% CI $99.00-153.22 million). We found a nonsignificant difference in number of deaths before age 70 years under current breastfeeding rates (4,396 additional premature deaths, 95% CI -810-7,918).
  
  
  CONCLUSIONS
  Suboptimal breastfeeding may increase U.S. maternal morbidity and health care costs. Thus, investigating whether the observed associations between suboptimal breastfeeding and adverse maternal health outcomes are causal should be a research priority.
authors.affiliation: Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts; the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, and the Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, North Carolina; the Departments of Medicine, Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; the Alliance for the Prudent Use of Antibiotics, Boston, Massachusetts; and the Department of Health Care Organization and Policy, School of Public Health, University of Alabama, Birmingham, Alabama.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Bartick
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Christine
authors.initials: C
authors.lastname: Luongo
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Reinhold
authors.forename: E Michael
authors.initials: EM
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001942:Breast Feeding / Q000191:economics / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008429:Maternal Welfare / Q000191:economics*; D008875:Middle Aged; D061213:Mortality, Premature; D015996:Survival Rate; D014481:United States; D055815:Young Adult