Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia

Abstract

Objective:

To perform an economic evaluation of a specific brand of partially hydrolyzed infant formula (PHF-W) in the prevention of atopic dermatitis (AD) among Australian infants.

Methods:

A cost-effectiveness analysis was undertaken from the perspectives of the Department of Health and Aging (DHA), of the family of the affected subject and of society as a whole in Australia, based on a decision-analytic model following a hypothetical representative cohort of Australian newborns who are not exclusively breastfed and who have a familial history of allergic disease (i.e., are deemed ‘at risk’). Costs, consequences, and incremental cost-effectiveness ratios (ICER) were calculated for PHF-W vs standard cow’s milk based infant formula (SF), and, in a secondary analysis, vs extensively hydrolyzed infant formula (EHF-Whey), when the latter was used for the prevention of AD.

Results:

From a representative starting cohort of 87,724 ‘at risk’ newborns in Australia in 2009, the expected ICERs for PHF-W vs SF were AU$496 from the perspective of the DHA and savings of AUD1739 and AU$1243 from the family and societal perspectives, respectively. When compared to EHF-Whey, PHF-W was associated with savings for the cohort of AU$5,183,474 and AU$6,736,513 from the DHA and societal perspectives.

Limitations:

The generalizability and transferability of results to other settings, populations, or brands of infant formula should be made with caution. Whenever possible, a conservative approach directing bias against PHF-W rather than its comparators was applied in the base case analysis. Assumptions were verified in one-way and probabilistic sensitivity analyses, which confirmed the robustness of the model.

Conclusions:

PHF-W appears to be cost-effective when compared to SF from the DHA perspective, dominant over SF from the other perspectives, and dominant over EHF-Whey from all perspectives, in the prevention of AD in ‘at risk’ infants not exclusively breastfed, in Australia.

Keywords::

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

Transparency

Declaration of funding

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

Declaration of financial/other relationships

MI is the president of PharmIdeas, which performed this study under contract with NNI; JS is employed by NNI; JS, SP, MT, PS, RH, and JS have received honoraria for their participation.

The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

We would like to acknowledge Peter Fryer, Dr Patrick Detzel, Bechara Farah, Jade Berbari, and Vincent Navarro for their analytical and editorial input.

Notice of Correction

The version of this article published online ahead of print on 19 September 2012 contained an error on the second page. There was an error in the wording of the Introduction which has been corrected for this version.