Relative cost-effectiveness of an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow's milk allergy in Italy

Abstract

ObjectiveTo estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG, (eHCF + LGG; Nutramigen LGG) as first-line management for cow’s milk allergy (CMA) compared with eHCF alone, soy-based formulae (SBF), hydrolyzed rice formulae (HRF), and amino acid formulae (AAF) in Italy, from the perspective of the Italian National Health Service (INHS) and parents.MethodsDecision modeling was used to estimate the probability of infants developing tolerance to cow’s milk by 18 months, based on an observational study dataset. The model also estimated the cost (at 2012/2013 prices) of health care resource use funded by the INHS and formulae paid for by parents over 18 months after starting a formula, as well as the relative cost-effectiveness of each of the formulae.ResultsThe probability of developing tolerance to cow’s milk by 18 months was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were fed eHCF + LGG compared to those fed one of the other formulae. The total health care cost of initially feeding infants with eHCF + LGG was less than that of feeding infants with one of the other formulae. Hence, eHCF + LGG affords the greatest value for money to both the INHS and parents of infants with either IgE-mediated or non-IgE-mediated CMA.ConclusionUsing eHCF + LGG instead of eHCF, SBF, HRF, or an AAF for first-line management of newly diagnosed infants with CMA in Italy affords a cost-effective use of publicly funded resources, and is cost-effective from the parents’ perspective, since it improves outcome for less cost. A randomized controlled study showing faster tolerance development in children receiving a probiotic-containing formula is required before this conclusion can be confirmed.

Relative cost-effectiveness of using an extensively hydrolyzed casein formula in managing infants with cow’s milk allergy in Brazil

“…The Italian decision models (as previously described 9 ) were adapted to reflect the structure of the health care system in Brazil and the context in which CMA is managed in this country. Similarly, patients’ pathways and resource use were adapted using estimates derived from a panel of general pediatricians (n=9), pediatric gastroenterologists (n=13), and pediatric allergists (n=9).…”

“…The models were populated with data from an observational study (as previously described). 8 , 9 The probability of infants developing tolerance to cow’s milk at different time points was calculated from the percentages of infants who developed oral tolerance to cow’s milk after being fed with a formula, as previously described for our Italian models. 9 …”

“…Therefore, the prescribed volumes that have been incorporated in models were consistent with the estimates previously described for our Italian study. 9 …”

“… 8 Data from this study (kindly provided by the study’s authors) were used for decision modeling to estimate the relative cost-effectiveness of using different first-line formulas for managing cow’s milk allergic infants in Italy. 9 …”

“…Notwithstanding this, the comparative health economic impact of extensively hydrolyzed formulas and AAFs in Brazil is unknown, and therefore, dietetic choices are based largely on their safety, nutritional value, and purchase cost. Hence, the objective of the current study was to amend the Italian decision models 9 to estimate the cost-effectiveness of using three alternative dietetic strategies in Brazil, from the perspective of the Brazilian public health care system, Sistema Único de Saude (SUS): 1) using an eHCF as a first-line formula, but switching to an AAF if infants remain symptomatic; 2) using an AAF as a first-line formula and then switching to an eHCF after 4 weeks once infants are symptom-free, but switching back to an AAF if infants become symptomatic; and 3) using an AAF as a first-line formula and keeping all infants on that formula.…”