Relative cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in Poland

Abstract

Objective

To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as an initial treatment for cow’s milk allergy compared with eHCF alone and amino acid formulas (AAF) in Poland from the perspective of the Polish National Health Fund (Narodowy Fundusz Zdrowia [NFZ]) and parents.

Methods

Decision modeling was used to estimate the probability of cow’s milk allergic infants developing tolerance to cow’s milk by 18 months. The model also estimated the cost to the NFZ and parents (Polish Zloty [PLN] at 2013–2014 prices) for managing infants over 18 months after starting one of the formulas as well as the relative cost-effectiveness of each of the formulas.

Results

The probability of developing tolerance to cow’s milk by 18 months was higher among infants who were fed eHCF + LGG (0.82) compared with those fed eHCF alone (0.53) or an AAF (0.22). An infant who is initially managed with eHCF + LGG is expected to consume fewer health care resources than infants managed with the other formulas. Hence, the estimated total health care cost incurred by the NFZ for initially feeding infants with eHCF + LGG (PLN 5,693) was less than that of feeding infants with eHCF alone (PLN 7,749) or an AAF (PLN 24,333). However, the total cost incurred by parents for initially feeding infants with an AAF (PLN 815) was marginally less than that of feeding with eHCF + LGG (PLN 993), which was less than that of feeding with eHCF alone (PLN 1,226).

Conclusion

Using eHCF + LGG instead of eHCF alone or an AAF for first-line management of newly diagnosed infants with cow’s milk allergy affords a cost-effective use of NFZ-funded resources, since it improves outcome for less cost. Whether eHCF + LGG would be viewed as being cost-effective by parents is dependent on their willingness to pay an additional cost for additional tolerance acquisition to cow’s milk.

Keywords:

• amino acid formula
• cost-effectiveness
• cow’s milk allergy
• extensively hydrolyzed formula
• Lactobacillus Rhamnosus GG
• Poland

Acknowledgments

This study was supported with an unrestricted research grant from Mead Johnson Nutrition (Poland) Sp. z o.o., Warszawa, Poland. However, Mead Johnson Nutrition had no influence on the following 1) the study design; 2) the collection, analysis, and interpretation of data; 3) the writing of the manuscript; and 4) the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and not necessarily those of Mead Johnson Nutrition.

The authors also wish to thank the following general pediatricians for their contributions to this study: Drs Monika Gołębiewska, Marek Ruszczynski, and Barbara Surowska, general pediatricians, Warsaw; Dr Małgorzata Skowron, general pediatrician, Gdansk; Dr Jolanta Słabczyńska-Kątnik, general pediatrician, Pulawe, Poland. The authors also wish to thank the following pediatric specialists for their contributions to this study: Dr Jacek Brodzicki, gastroenterologist, Gdańsk; Dr Maria Kotowska, gastroenterologist, Warszawa; Dr Emil Florkiewicz, allergist, Sieradz; Dr Anna Maron, allergist, Wrocław, Poland.

Disclosure

The authors report no conflicts of interest in this work.