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

Guest, Julian F.; Singh, Heenal

doi:10.1080/03007995.2019.1612339

Cited by 10 publications

(15 citation statements)

References 19 publications

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“…25 Resource estimation was obtained from GPs practicing in the United Kingdom and has been used in a previously published costeffectiveness analysis. 27 The prices of resources were obtained from standard, publicly available UK sources.…”

Section: Discussionmentioning

confidence: 99%

“…To estimate the amount of resources required to manage CMPA and its allergic manifestations we used results from a published survey conducted with UK general practitioners reported by Guest and Singh. 27 We subsequently validated these findings with a UK paediatric allergist to ensure these were still adequate to current UK practice and national guidance. Consequently, we have introduced serum IgE testing as one of the required resources 30 and have identified the pharmacological formulations suitable for use in paediatrics to include in the costing calculations.…”

Section: Costs and Resource Usementioning

confidence: 94%

“…We developed a trial-based decision analytic cohort model in Microsoft Excel to simulate the use of hypoallergenic formulas to manage IgE-mediated CMPA in non-breastfed children in the United Kingdom. The model structure was based on a published costeffectiveness analysis in the United Kingdom, 27 and applies the UK National Health Service (NHS) perspective for costs. In the United Kingdom, health care is free at the point of access and children are exempt from prescription fees.…”

Section: Model Structurementioning

confidence: 99%

“…32 When required, costs were inflated to current values using the Pay and Price Index. 33 Monthly hypoallergenic formula requirements followed the values collected as part of the original survey 27 with 11 cans being required up to the age of 6 months, 9 cans for children aged 6 to 12 months, 7 cans from 12 to 18 months, and 6 cans from 18 to 24 months. The average prices for each comparator were calculated using values sourced from the NHS Dictionary of Medicines and Devices, 36 which were weighted according to the market share of formulations available for each type of hypoallergenic formula.…”

Section: Costs and Resource Usementioning

confidence: 99%

“…We have not attempted to extrapolate the effect of hypoallergenic formulas, as this was thought to increase uncertainty in the analysis, and because it did not modify the conclusions of a previously published cost-effectiveness analysis. 27 The outcome measures of interest assessed in our cost-effectiveness analysis were the likelihood of being free from allergic symptoms and cow's milk tolerance, rather than quality-adjusted life years, commonly performed in UK economic evaluations. 38 There are several reasons for not including quality-adjusted life years in this cohort of children that are worth considering.…”

Section: Journal Of Health Economics and Outcomes Researchmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Costs and Resource Usementioning

confidence: 94%

Section: Model Structurementioning

confidence: 99%

Section: Costs and Resource Usementioning

confidence: 99%

Section: Journal Of Health Economics and Outcomes Researchmentioning

confidence: 99%

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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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The Economic Burden of Food Allergy: What We Know and What We Need to Learn

Fong

Ahlstedt

Golding

et al. 2022

Curr Treat Options Allergy

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Purpose of Review Food allergy management and treatment require dietary modification, are associated with significant burdens, and affect food choices and behaviours. Emerging therapies, such as oral immunotherapy (OIT), provide a glimmer of hope for those living with the condition. Some burdens have received substantial focus, whereas many knowledge gaps on the significance of other impacts, including economic burden, remain. Recent Findings Evidence from many countries, but disproportionately from the United States, supports that food allergy carries significant healthcare and societal costs. Early introduction for the prevention of food allergies is theoretically cost-effective, but remains largely undescribed. Unique considerations, such as those to cow’s milk protein allergy, which affects a substantial proportion of infants, and adrenaline autoinjectors, which have a high cost-per-use, require a balance between cost-effectiveness to the healthcare system and adverse outcomes. Household costs have largely been explored in two countries, but owing to different healthcare structures and costs of living, comparisons are difficult, as are generalisations to other countries. Stock epinephrine in schools may present a cost-effective strategy, particularly in economically disadvantaged areas. Costs relating to OIT must be examined within both immediate benefits, such as protection from anaphylaxis, and long-term benefits, such as sustained unresponsiveness. Summary Although the absolute costs differ by region/country and type of food allergy, a consistent pattern persists: food allergy is a costly condition, to those who live with it, and the multiple stakeholders with which they interact. Supplementary Information The online version contains supplementary material available at 10.1007/s40521-022-00306-5.

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Cost-effectiveness of infant hypoallergenic formulas to manage cow’s milk protein allergy in France

Paquete¹,

Martins

Connolly

et al. 2022

Journal of Market Access & Health Policy

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Background Clinician’s choice of hypoallergenic formulas in the first-line management of cow’s milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and cost-effectiveness. Objective We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France. Methods Immunotolerance and atopic manifestations’ prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives. Results Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses. Conclusions EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs.

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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

Cited by 10 publications

References 19 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

The Economic Burden of Food Allergy: What We Know and What We Need to Learn

Cost-effectiveness of infant hypoallergenic formulas to manage cow’s milk protein allergy in France

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