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Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management
Narissara Suratannon1,2, Panote Prapansilp3, Athitaya Srinarongsook3
1Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
The most cost-effective management for cow's milk protein allergy (CMPA) in non-breastfed infants is extensively hydrolyzed casein formula with probiotic GG (EHCF+LGG). This approach leads to better symptom-free outcomes and potential cost savings in CMPA treatment.
Area of Science:
- Pediatric Allergy and Immunology
- Health Economics
- Nutritional Science
Background:
- Cow's milk protein allergy (CMPA) is the most prevalent food allergy in children.
- Therapeutic infant formulas are crucial for managing CMPA, promoting tolerance, and preventing the allergic march in non-breastfed infants.
- Assessing cost-effectiveness of different formulas is vital for resource allocation in developing countries.
Purpose of the Study:
- To evaluate the cost-effectiveness of various therapeutic infant formulas for managing CMPA in Thailand.
- To compare the economic impact and clinical outcomes of EHCF+LGG, EHWF, SPF, and AAF over 36 months.
- To provide insights relevant to developing Asian nations regarding CMPA management strategies.
Main Methods:
- An analytic decision model simulated CMPA outcomes (eczema, urticaria, asthma, rhinoconjunctivitis, symptom-free) over 36 months.
- Comparative effectiveness data were derived from a prospective cohort study.
- Healthcare resource utilization was estimated by local experts, with costs sourced from public data.
Main Results:
- The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881).
- EHCF+LGG demonstrated potential savings of USD 370 (vs. SPF), USD 1,071 (vs. EHWF), and USD 6,161 (vs. AAF) over 36 months.
- EHCF+LGG was associated with a higher rate of immune tolerance and symptom-free status in infants with CMPA.
Conclusions:
- Extensively hydrolyzed casein formula with probiotic GG (EHCF+LGG) is the most cost-effective strategy for managing non-breastfed infants with CMPA.
- This approach not only improves clinical outcomes, including tolerance induction, but also offers significant overall cost savings.
- The findings support the use of EHCF+LGG as a preferred therapeutic option in similar healthcare settings.
Abstract:
Cow's milk protein allergy (CMPA) is children's most common food allergy. Therapeutic infant formulas for CMPA lead to symptom-free and potentially benefit early tolerance induction and reducing the allergic march in non-breastfed babies. This study assessed the cost-effectiveness of CMPA management with different therapeutic infant formulas in Thailand, which may reflect situations in developing countries throughout Asia. An analytic decision model was developed to simulate the occurrence of eczema, urticaria, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA over 36 months. Extensively hydrolyzed casein formula with added probiotic Lacticaseibacillus rhamnosus (previously Lactobacillus rhamnosus) strain GG (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), soy protein-based formula (SPF), and amino acid formula (AAF) were compared from the healthcare payer perspective. The results from a prospective cohort study were used for comparative effectiveness measures, while local experts were interviewed to estimate the healthcare resource used in the management of CMPA. The costs of healthcare resources were obtained from standard, publicly available sources. The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881). Compared with other formulas, EHCF+LGG was expected to save USD 370 (SPF), USD 1,071 (EHWF), and USD 6,161 (AAF) in the total cost of CMPA management over 36 months. In conclusion, EHCF+LGG was the most cost-effective strategy for managing non-breastfed infants with CMPA. This strategy was associated with more children developing immune tolerance to cow's milk and being symptom-free, contributing to overall cost-saving potential.
