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

Abstract

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.

Growth pattern of paediatric patients affected by cow milk protein allergy fed with rice hydrolyzed formula

“…29 Another important point is the cost-effectiveness of HRPF; in fact, in a recent study, hypoallergenic formulas accounted for the largest proportion of the total cost of managing CMPA, averaging 69% across all comparators, with a minimum of 58% for HRPF and a maximum of 87% for amino acid-based formulas. 30 However, according to the ESPGHAN position paper, 31 it is important to consider the arsenic content of HRPFs, as this is not stated for all commercial HRPFs. 32 Therefore, only HRPFs whose the arsenic content is known and within the recommended limits should be used.…”

“…In addition, a recent survey of Spanish paediatricians on this topic showed that HRPF was indicated as the second preferred alternative formula after EHF, and that more than 80% of paediatricians believed that HRPF was better accepted by infants in terms of organoleptic qualities compared to EHF, as far as taste preferences are concerned 29 . Another important point is the cost‐effectiveness of HRPF; in fact, in a recent study, hypoallergenic formulas accounted for the largest proportion of the total cost of managing CMPA, averaging 69% across all comparators, with a minimum of 58% for HRPF and a maximum of 87% for amino acid‐based formulas 30 …”

Symptoms and management of cow's milk allergy: perception and evidence

“…A study by Martin et al indicates that eHCF combined with LGG is the most costeffective strategy for treating CMA in the United Kingdom ( 39 ). According to a French study conducted by Paquete et al, the combination of eHCF and LGG was associated with longer symptom-free periods, greater immune tolerance, and reduced costs ( 40 ).…”

Symptoms and Management of Cow’s Milk Allergy: Perception and Evidence

“…A study by Martin et al indicates that eHCF combined with LGG is the most cost-effective strategy for treating CMA in the United Kingdom [39]. According to a French study by Paquete et al, the combination of eHCF and LGG was associated with longer symptom-free periods, greater immune tolerance, and reduced costs [40].…”