Modelling the resource implications and budget impact of managing cow milk allergy in Australia

ABSTRACT

Objective: To estimate the resource implications and budget impact of current clinical practice for managing cow milk allergy (CMA) in Australia, from the perspective of the publicly funded healthcare system.

Methods: A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the expected 6-monthly levels of healthcare resource use and corresponding costs attributable to managing 6150 new CMA sufferers following referral to a specialist.

Results: The expected 6-monthly costs of managing 6150 newly-diagnosed infants with CMA following referral to a specialist was an estimated (Australian dollars, AU$) AU$6.5 million at 2006/07 prices. Clinical nutrition preparations were found to be the primary cost driver accounting for 62% of the total 6-monthly cost and clinician visits were the secondary cost driver accounting for up to a further 28% of the total 6-monthly cost. Sensitivity analysis showed there would be fewer visits to hospital-based paediatric gastroenterologists and paediatric immunologists/allergists if all newly-diagnosed patients were prescribed an amino acid formula (AAF) following referral to a specialist, instead of being managed according to current practice.

Conclusion: CMA imposes a substantial burden on the publicly funded healthcare system in Australia. However, using an AAF as the initial treatment for CMA can potentially release limited hospital resources for alternative use within the paediatric healthcare system.

Key words: :

• Amino acid formula
• Australia
• Cost
• Cow milk allergy
• Extensively hydrolysed formula
• Soy

Acknowledgements

Declaration of interest: This study was sponsored financially by SHS International Ltd, Liverpool, UK, manufacturers of the AAF, Neocate. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript.

The authors would like to thank the following paediatricians for their contributions: Dr J Brereton, Sydney; Dr P Egan, Adelaide; Dr G Ford, Melbourne; Dr C Hughes, Sydney; Dr P Lang, Adelaide; Dr D Levitt, Brisbane; Dr J Mel, Melbourne; Dr B Lewis, Brisbane; Dr L Lubitz, Melbourne; Dr D McCrossin, Brisbane; Dr S Ong, Sydney; Dr R Power, Adelaide; Dr D Roberts, Perth; Dr J Scurlock, Perth; Dr M Slattery, Perth.

The authors would also like to thank the following paediatric gastroenterologists for their contributions: Dr D Cameron, Melbourne; Dr A Day, Sydney; Dr L Ee, Brisbane; Dr P Hammond, Adelaide; Dr P Lewindon, Brisbane; Dr D Moore, Adelaide; Dr W Hardikar, Melbourne.

Last, but not least, the authors would also like to thank the following paediatric immunologists/allergists for their contributions: Dr R Heine, Melbourne; Dr D Hill, Melbourne; Dr M Gold, Adelaide; Prof. A Kemp, Sydney; Dr J Peake, Brisbane; Dr S Prescott, Perth; Dr P Smith, Sunshine Coast; Dr M Tang, Melbourne.