Economic evaluation of a 100% whey-based, partially hydrolysed formula in the prevention of atopic dermatitis among French children

Abstract

Objective:

A pharmacoeconomic analysis was performed to determine costs, consequences and cost effectiveness of a partially hydrolysed 100% whey-based infant formula, NAN HA, manufactured by Nestlé S.A, Switzerland (PHF-W) and branded under Nidal Excel HA in France, in the prevention of atopic dermatitis (AD) in ‘at risk’ children when compared to standard cows’ milk formula (SF) in France.

Methods:

A decision-analytic economic model depicting AD treatment pathways, as well as resource utilisation and costs associated with the treatment of AD in healthy yet ‘at risk’ French newborns who cannot be exclusively breastfed was constructed for a 12-month time horizon, including an initial 6 months of intervention with formula consumption. Model inputs were based on the literature, official formularies and expert opinion. The modelled treatment pathways included a dietary management approach (formula change), a medical treatment approach and a combination thereof. The final outcome was the expected cost per avoided case of AD, yielding an incremental cost per avoided case (ICER) of AD when comparing subjects who used PHF-W versus SF. Outcomes were presented from three perspectives: the French Ministry of Health (MOH), the subjects’ family and society as a whole. A secondary analysis also compared PHF-W to extensively hydrolysed formula (EHF) in prevention.

Results:

The number of avoided AD cases by selecting PHF-W over SF was 13 356 cases in a birth cohort of 185 298 ‘at risk’ infants. The base case analysis, at 65% reimbursement, yielded expected ICERs of €1343, € –624 (savings) and €719 from the MOH, family and societal perspectives, respectively. From all three perspectives, the highest cost was attributable to formula. In case of a 35% reimbursement rate for PHF-W, the ICER was €615 from the MOH perspective, while the use of PHF-W was cost neutral at 10% reimbursement. PHF-W was cost-saving against EHF (€98–€116 million savings depending on type of EHF), when this latter was used in prevention. One-way and probabilistic sensitivity analyses confirmed the robustness of the model.

Conclusion:

Under a certain range of assumptions, this analysis based on predictive modelling has established the cost effectiveness of PHF-W in the prevention of AD in infants.

Key words::

• Allergy
• Atopic dermatitis
• Cost-effectiveness analysis
• Economic
• Infant formula
• Infant nutrition
• Prevention

Transparency

Declaration of funding

This study was funded by Nestlé Nutrition Institute (NNI).

Declaration of financial/other relationships

M.I. and B.F. are employed by PharmIdeas, which performed this study under contact with NNI; J.S. and F.H. are employed by NNI; C.D., G.K. and F.R. have received honoraria for their participation.

Acknowledgements

The authors would like to acknowledge Jade Berbari for his editorial assistance, as well as Drs. Jean-Jacques Rives, Rémy Assathiany and Hania Szajewska for their clinical input.