startclasThe cost calculator is based on whether determining an effect per unit change in breast–feeding rates at each time point in the model (initiation, 3 months exclusive, 6 months exclusive, 6 months any breastfeeding, 12 months, 18 months).   The user could then calculate the per-person effect of essentially any change in breastfeeding rates, and then multiply by the demographics of the state of locality of interest (number of births, number of women, proportion preterm infants, and proportion non-Hispanic black), to generate an estimate of effect.

We have pre-populated the demographic data for each US state. However, costs savings individual localities, such as cities or counties, one can manually enters the demographic information. If specific demographic information for the locality is not known, the default information can be chosen from one the states, or from the US as a whole.

Limitations of the results: The results of this calculator may not be generalizable beyond the US.

The cost calculator was based on a computer model taken from the literature on the effect of breastfeeding on 9 pediatric diseases and 5 maternal diseases in the industrialized world. The effect of breastfeeding on some of these conditions may be very different in the developing world, particularly pediatric gastrointestinal infections. Some conditions may differ dramatically from one industrialized country to another, such as SIDS, which is lower in Japan than in the US and the UK.

Next, incidences of the cases are determined based on demographic disparities that exist in the United States, which is influenced by factors such as differential access to health care.

Finally, costs used in this calculator are based on US health care costs, which tend to be higher than in countries with universal health care.

It must also be stated that the literature around breastfeeding and disease is continually evolving. Health outcomes that were once thought to be heavily impacted by breastfeeding are now no longer thought to be, such as asthma and eczema, and other health outcomes are now thought to have a much stronger association with breastfeeding than previously appreciated, such as SIDS and necrotizing enterocolitis. The current model is based on the assumption that the population and current breastfeeding rates remain constant. If breastfeeding rates improve, and/or if population growth slows, cost savings will be less.

I understand the following limitations and agree to the following conditions:

-These results are estimates and cannot be guaranteed.

–The calculator assumes that the maximum percentage of women who will be able to initiate BF is 90%. This percentage was chosen because it allows for the realization that not all mother-infant dyads can initiate breastfeeding based on the literature.1

–The calculator assumes that 100% of women who did initiate breastfeeding can continue to provide at least some of their infant’s feedings through 18 months of age.

–The calculator assumes that changing the initiation rate means that all breastfeeding rates following initiation also change. The degree of change for future rates is standardized to the current degree of rate changes identified by IFPS-II surveys.

–The calculator assumes that if changing breastfeeding percentage after breastfeeding initiation (e.g. any breastfeeding at 6 months) means that all breastfeeding rates following that time point also change. This degree of change is standardized to the current change rates identified by Infant Feeding Practice-II (IFPS-II) survey.

-The calculator assumes that changing a breastfeeding percentage after breastfeeding initiation e.g. any BF at 6 months) means that all breastfeeding rates prior to that time point also change. This degree of change is standardized to the current change rates identified by IFPS-II surveys or is defaulted to the maximum percentage, whichever is lower.

The research upon which the calculator was based2 has the following limitations:

-It is based on the literature on assumption of breastfeeding rates, disease rates, death rates, and costs. While we intend to update breastfeeding rates yearly as the CDC updates them every August, these and other assumptions could be incorrect or could change over time. Note that our research used the most conservative estimates in the literature. Note that for many of the childhood diseases, “any breastfeeding” was used as the comparator to “no breastfeeding,” not exclusive breastfeeding.

-We assumed that associations between breastfeeding and disease are causal. Note that we used risks for the published literature that controlled for multiple socio-demographic confounders.

-The research assumes a steady state over the lifetime of the modeled cohort that forms the basis of the calculator: that population size, fertility rates, disease rates, mortality rates, and breastfeeding rates do not change.

-Use of US costs may limit the generalizability of this calculator to other countries.

-The selection of appropriate costs for the loss of human life is controversial.

Please cite all results obtained from the calculator as follows: Breastfeeding Saves Lives Calculator, bfsavings.com, Access date and year.

REFERENCES:

  1. Stuebe AM, Horton BJ, Chetwynd E, Watkins S, Grewen K, Meltzer-Brody S. Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. J Womens Health (Larchmt). 2014;23(5):404-412.
  2. Bartick MC, Schwarz EB, Green BD, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2016.