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

Abstract

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.

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

“…Annual probabilities of being symptom free were estimated as one minus the sum of the probabilities of any AM for that year. The efficacy parameters, except for RHF were previously published in a cost-effectiveness analysis for the UK [ 29 ], and are depicted in Table 1 .…”

Managing Cow’s Milk Protein Allergy in Indonesia: A Cost-effectiveness Analysis of Hypoallergenic Milk Formulas from the Private Payers’ Perspective

“…A previously published trial-based decision analytic cohort model was adapted to simulate the use of hypoallergenic formulas to manage IgE-mediated CMPA in non-breastfed children in Indonesia. 22 The model structure was primarily published on a cost-effectiveness analysis in the UK. 22 Data from a prospective trial directly comparing AAF, EHCF+LGG, EHWF, and RHF were used to inform annual probabilities of AM and of acquiring immunotolerance to CMP over the 3-year time horizon of the analysis.…”

“…22 The model structure was primarily published on a cost-effectiveness analysis in the UK. 22 Data from a prospective trial directly comparing AAF, EHCF+LGG, EHWF, and RHF were used to inform annual probabilities of AM and of acquiring immunotolerance to CMP over the 3-year time horizon of the analysis. 17 To follow children during the period in which they most often develop CMPA symptoms, the study considered a time horizon of 3 years.…”

“…17 The efficacy parameters used in the model (annual probability of each CMPA symptom, of being symptom-free and of acquiring cow's milk tolerance) were previously published. 22…”

“…17 Previous health economic analyses have explored the cost-effectiveness of hypoallergenic formulas in managing infants with CMPA in Italy, Spain, Poland, and the United Kingdom (UK), but none have used head-to-head comparative data over a 36-month period in Indonesia. [18][19][20][21][22] The objective of this economic evaluation was to assess the cost-effectiveness of commonly used hypoallergenic milk formulas in infants and young children presenting with IgE-mediated CMPA in Indonesia (AAF, EHCF+LGG, extensively hydrolyzed whey formula [EHWF], and SF), applying the most recent evidence in the field. We have considered information on healthcare resource utilization in several cities in Indonesia.…”