Budget Impact of Early Introduction of Amino Acid Formula in Managing Infants with Cow Milk Protein Allergy: Arabian Gulf Countries’ Experience

Abstract

Objective

This study estimates the budgetary impact of the introduction of amino-acid formula (AAF) as first-line management in the elimination diet of infants with suspected cow milk protein allergy (CMPA) in the Kingdom of Saudi Arabia (KSA), Kuwait, and the United Arab Emirates (UAE) from a health-care payer’s perspective.

Methods

A global decision tree model was adapted to compare estimated costs in current practice (extensively hydrolyzed formula [eHF] or soy formula [SF] with the proposed approach of early introduction of AAF as first-line treatment of CMPA in non-breast-fed infants). Model inputs were derived from explorative literature reviews and medical experts’ opinions. All costs were reported in local currency, ie, Saudi Riyal (SAR) for KSA, Kuwaiti Dinar (KWD) for Kuwait, and United Arab Emirates Dirham (AED) for the UAE.

Results

Cost savings with the early introduction of AAF were 10% (SAR 15102542) in KSA, 10% (KWD 306565) in Kuwait, 17% (AED 1842018) in the UAE government sector and 13% (AED 4232932) in the UAE private sector. The highest cost reduction was observed in the cost of soy formula (SF), with a 58% reduction both in KSA (SAR 4204540) and UAE public sector (AED 110331). A significant cost reduction in medication costs in Kuwait (37%; KWD 5630) and medical examination costs in the UAE private sector (50%; AED 1508918) was observed.

Conclusion

Results indicated that the introduction of AAF as the first line in the management of CMPA is a cost-saving strategy for the Gulf Cooperation Council (GCC) countries—KSA, Kuwait, and UAE— from a health-care payer’s perspective.

Keywords:

• cow’s milk protein allergy
• amino acid formula
• infants
• Kingdom of Saudi Arabia
• Kuwait
• United Arab Emirates
• Arabian Gulf

Abbreviations

AAF, Amino acid formula; AED, United Arab Emirates Dirham; CMPA, Cow Milk Protein Allergy; eHF, Extensively Hydrolyzed Formula; ESPGHAN, The European Society for Paediatric Gastroenterology Hepatology and Nutrition; GCC, The Gulf Cooperation Council; Ig, Immunoglobulin; KSA, The Kingdom of Saudi Arabia; KWD, Kuwaiti Dinar; OFC, Oral Food Challenge; RAST, Radioallergosorbent test; SAR, Saudi Riyal; SF, Soy Formula; UAE, The United Arab Emirates.

Data Sharing Statement

Data are available upon valid request by contacting the corresponding author by email.

Acknowledgments

The authors would like to thank Koshu Mahajan and Vibha Dhamija from IQVIA for their medical writing and editing support.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation. All the authors took part in drafting, revising and critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work, according to ICMJE authorship criteria. All authors ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

Prof. Mohamed Miqdady received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events and consulting fees from Nutricia, Nestle, Novalac. Prof. Mohamed Miqdady received support from Nutricia for the manuscript. Dr. Christos Tzivinkos received Speaker Honoraria from Nutricia, Abbvie, Takeda and Nestle. Dr. Christos Tzivinkos received travel support from Nutricia and Nestle. The authors report no other conflicts of interest in this work.

Additional information

Funding

Funding for the study was provided by Nutricia Middle East DMCC. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.