Cost-Effectiveness of Partially Hydrolyzed Whey Protein Formula in the Primary Prevention of Atopic Dermatitis in High-Risk Urban Infants in Southeast Asia

Abstract

Background: Atopic dermatitis (AD) is one of the most common skin conditions among infants. Proteins found in cow's milk formula (CMF) have been found to be attributable to heightened AD risk, particularly in infants with familial AD heredity. Previous studies have suggested that intervention with partially hydrolyzed formula in nonexclusively breastfed infants can have a protective effect against AD development. Objective: The aim of the present study was to compare the estimates of the economic impact of reducing the AD incidence by feeding a partially hydrolyzed whey-based formula (PHF-W) instead of a standard CMF to high-risk nonexclusively breastfed urban infants for the first 17 weeks of life in the Philippines, Malaysia, and Singapore. Methods: In each country, a mathematical model simulated AD incidence and burden from birth to 6 years of age of using PHF-W versus CMF in the target population using data from the German Infant Nutritional Intervention study. The models integrated literature, current cost and market data, and expert clinician opinion. Modeled outcomes included AD risk reduction, time spent after AD diagnosis, AD symptom-free days, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs were expressed in USD. Results: Feeding high-risk infants PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI 1-24) AD risk reduction, a 0.69-year (95% CI 0.25-1.13) reduction in the time spent after AD diagnosis per child, reductions of 16-38 AD days, and gains in 0.02-0.04 QALYs, depending on the country. The per-child AD-related 6-year cost-saving estimates of feeding high-risk infants with PHF-W versus CMF were USD 739 in Singapore, USD 372 in Malaysia, and USD 237 in the Philippines.

Emerging trends in nutraceutical applications of whey protein and its derivatives

“…Children constitute the vulnerable group for cow milk protein allergy (CMPA), 2-7 % of them developing this intolerance (Solinas et al 2010). Atopic dermatitis is a major manifestation of this allergy (Botteman and Detzel 2015). Respiratory allergies include asthma, rhinitis, wheezing, coughing, and laryngeal edema (Hochwallner et al 2014).…”

Understanding economic evidence for the prevention and treatment of atopic eczema

“…Of the studies found within this review, the most commonly evaluated intervention types were topical calcineurin inhibitors (n = 14), [15][16][17][18][19][20][21][22][23][24][25][26][27][28] followed by infant formula feeds intended to prevent eczema from developing (n = 10). [29][30][31][32][33][34][35][36][37][38] Six studies evaluated a change of service delivery, including the use of web-based consultations, 39 delivering care by a nurse practitioner, [40][41][42] the development of a paediatric dermatology service (although what this entailed was not described) 43 and the use of interdisciplinary group sessions with an educational counterpart. 44 Mason et al also evaluated an educational support programme, which included the provision of an educational DVD and telephone support.…”

“…The variety of interventions considered were relatively limited when compared with the 240 intervention groups listed on the GREAT database. Of the studies found within this review, the most commonly evaluated intervention types were topical calcineurin inhibitors ( n = 14), followed by infant formula feeds intended to prevent eczema from developing ( n = 10) . Six studies evaluated a change of service delivery, including the use of web‐based consultations, delivering care by a nurse practitioner, the development of a paediatric dermatology service (although what this entailed was not described) and the use of interdisciplinary group sessions with an educational counterpart .…”

Treatment of Childhood Atopic Dermatitis and Economic Burden of Illness in Asia Pacific Countries

“…A total of 5 published studies were identified (table 1): 2 for Australia [32,33], 1 for South Korea [34], 1 for Thailand [35] and 1 for the Philippines [36], which required reanalyses to generate some of the outcomes presented herein. These studies were further complemented with unpublished analyses conducted by some of the coauthors in Indonesia, Malaysia and Singapore [37].…”