Cost-effectiveness of using an extensively hydrolyzed casein formula containing <i>Lactobacillus rhamnosus</i> GG in managing infants with cow’s milk allergy in the US

Guest, Julian F.; Kobayashi, Roger H.; Mehta, Vinay; Neidich, Gary

doi:10.1080/03007995.2017.1400962

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…9,18 Previous economic analyses were conducted assessing the costeffectiveness of hypoallergenic formulas, but these were based on efficacy evidence collected over a maximum of 18 months. [20][21][22][23][24] A recent publication reported on the incidence of allergic manifestation and cow's milk tolerance over three years, in children treated with different formulas. 25 To inform clinical practice and health system efficiency, we compared the cost-effectiveness of amino acid-based formula (AFF), extensively hydrolysed casein formula containing Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolysed whey formula (EHWF), and soy formula (SF), in managing CMPA in children.…”

mentioning

confidence: 99%

Cost-effectiveness Analysis of Hypoallergenic Milk Formulas for the Management of Cow’s Milk Protein Allergy in the United Kingdom

Martins

Connolly

Minshall

2021

JHEOR

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Background: Cow’s milk protein allergy (CMPA) is the most common food allergy in early childhood. In most children CMPA resolves by age 5 or 6; however, if not treated correctly can provoke nutritional deficiency resulting in poor growth. Management consists of excluding cow’s milk from the diet, with hypoallergenic formulas (or non-dairy alternatives) being introduced to meet nutritional requirements. Objectives: To compare the cost-effectiveness of hypoallergenic formulas in reducing allergic manifestations and promoting immune tolerance in infants with immunoglobulin E (IgE)-mediated symptoms of CMPA. Methods: A trial-based decision analytic cohort model was developed to simulate the occurrence of urticaria, eczema, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA in the United Kingdom. Amino acid-based formula (AAF), extensively hydrolysed casein formula containing Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolysed whey formula (EHWF), and soy formula (SF) were compared using the National Health Service (NHS) perspective, 3-year time horizon and 3.5% discount rate for cost and health consequences. Hypoallergenic formulas comparative efficacy was sourced from a prospective cohort study. Resources required to manage allergic symptoms were sourced from published literature, validated by a UK clinician, and applied to UK cost resources. Results were reported as cost per additional child free from allergic manifestations at 3 years and cost per additional immune tolerant child at 3 years. Results: In the base case, infants receiving EHCF+LGG were associated with lower NHS resource use and improved CMPA tolerance. Over the 3-year treatment period, savings of £119, £476, and £1094 were achieved with EHCF+LGG compared to SF, EHWF and AAF, respectively. Infant formula accounted for the largest proportion of resource consumption averaging 44% for all comparators, with a minimum of 31% for SF and a maximum of 53% for AAF over 3 years. General practitioners’ visits constituted the second highest cost component, approximately 17% of total costs across comparators. The results were robust to deterministic and probabilistic sensitivity analyses. Conclusions: Compared to AAF, SF, and EHWF hypoallergenic formulas, EHCF+LGG was the most cost-effective, associated with lower total costs and contributing to a higher proportion of children being symptom-free and developing immune tolerance 3-years after diagnosis.

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mentioning

confidence: 99%

Cost-effectiveness Analysis of Hypoallergenic Milk Formulas for the Management of Cow’s Milk Protein Allergy in the United Kingdom

Martins

Connolly

Minshall

2021

JHEOR

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“…However, the economic analysis also showed that initial management with eHCF plus LGG affords a cost-effective dietetic strategy over a period of 3 years across all measures of effectiveness. Additionally, we have previously reported that initial management of both IgE-mediated and non-IgE-mediated CMPA with eHCF plus LGG affords a cost-effective dietetic strategy when compared to both an eHCF alone and amino acid formulae over a period of 18 months in different countries [6][7][8][9][10] . Consequently, our studies would suggest that the probability of eHCF plus LGG being a cost-effective formula for the initial management of CMPA is sustained from 18 months over a period of 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies comparing different formulae found that feeding cow's milk allergic children with an extensively hydrolyzed casein formula (eHCF) supplemented with the probiotic Lactobacillus rhamnosus GG (LGG) (Nutramigen Ã LGG V R ; eHCF plus LGG) resulted in higher acquisition of tolerance to cow's milk protein compared with those fed an eHCF without LGG and other formulae 4,5 . Additionally, feeding eHCF plus LGG first line to both immunoglobulin E (IgE)-mediated and non-IgE-mediated cow's milk allergic infants, compared to feeding with an eHCF alone or an amino acid formula, was found to be cost-effective in Italy 6 , Spain 7 , Poland 8 and the US 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of using an extensively hydrolyzed casein formula supplemented with Lactobacillus rhamnosus GG in managing IgE-mediated cow’s milk protein allergy in the UK

Guest

Singh

2019

Current Medical Research and Opinion

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Objective: To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) plus the probiotic Lactobacillus rhamnosus GG (eHCF plus LGG; Nutramigen Ã LGG V R) compared to an eHCF alone as first-line dietary management for Immunoglobulin E (IgE)-mediated cow's milk protein allergy (CMPA) in the UK. Methods: Decision modelling was undertaken to estimate the probability of IgE-mediated cow's milk allergic infants being symptom free (i.e. not experiencing urticaria, eczema, asthma or rhinoconjunctivitis) and developing tolerance to cow's milk by 5 years. The model also estimated the cost (at 2016/ 2017 prices) of healthcare resource use funded by the UK's National Health Service (NHS) over 5 years after starting a formula, as well as the relative cost-effectiveness of the two dietary formulae. Results: At 5 years after the start of a formula the probability of being symptom free was estimated to be 0.97 and 0.76 among infants who were originally fed eHCF plus LGG and an eHCF alone, respectively. This encompassed the probability of children being asthma free at 5 years after the start of treatment, which was 0.99 and 0.91 in the eHCF plus LGG and eHCF alone groups, respectively. Additionally, the probability of acquiring tolerance to cow's milk was estimated to be 0.94 and 0.66 among infants who were originally fed eHCF plus LGG and an eHCF alone, respectively. The estimated total healthcare cost over 5 years of initially feeding infants with eHCF plus LGG was less than that of feeding infants with an eHCF alone (£4229 versus £5136 per patient). Conclusions: First-line management of newly diagnosed infants with IgE-mediated CMPA with eHCF plus LGG instead of an eHCF alone improves outcome, releases healthcare resources for alternative use, reduces the NHS cost of patient management and thereby affords a cost-effective dietetic strategy to the NHS.

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“…1), covering 3 types of food allergy and published between 2009 and 2019. Eight papers investigated PA, [24][25][26][27][28][29][30][31] 8 investigated CMA, [32][33][34][35][36][37][38][39] and 1 focused on EA. 40…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

et al. 2021

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Cost-effectiveness of using an extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in the US

Abstract: Initial management of newly-diagnosed cow's milk allergic infants with eHCF + LGG was found to afford a cost-effective strategy to both third-party insurers and parents when compared to an eHCF alone or an AAF.

Cited by 9 publications

References 28 publications

Cost-effectiveness Analysis of Hypoallergenic Milk Formulas for the Management of Cow’s Milk Protein Allergy in the United Kingdom

Cost-effectiveness Analysis of Hypoallergenic Milk Formulas for the Management of Cow’s Milk Protein Allergy in the United Kingdom

Cost-effectiveness of using an extensively hydrolyzed casein formula supplemented with Lactobacillus rhamnosus GG in managing IgE-mediated cow’s milk protein allergy in the UK

Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

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