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

Figures & data

Table 1 Unit costs 2013–2014 prices (PLN)

	NFZ value	Parent value	Reference
Clinician visits
Pediatric allergist visit	33.01	0.00	^Citation13
Pediatric gastroenterologist visit	33.71	0.00	^Citation13
Dermatologist visit	29.12	0.00	^Citation13
Tests performed by pediatric specialists
Skin prick test	38.90	0.00	^Citation13
RAST	38.90	0.00	^Citation13
Atopy patch test	38.90	0.00	^Citation13
Oral food challenge	2,704.00	0.00	^Citation13
Tests performed by general pediatrician
Skin prick test	0.00	38.90	^Citation13
RAST	0.00	38.90	^Citation13
Atopy patch test	0.00	38.90	^Citation13
Oral food challenge	2,704.00	0.00	^Citation13
Formulas
eHCF 1	18.31	17.54	^Citation14
eHCF 2	22.44	14.12	^Citation14
eHCF + LGG 1	16.09	29.94	^Citation14
eHCF + LGG 2	31.67	17.13	^Citation14
AAF	149.35	3.20	^Citation14
Prescribed drugs
Proton pump inhibitors (for 2 months)	0.00	59.42	^Citation15
Emollients (for 6 months)	0.00	210.19	^Citation15
Corticosteroids (for 10 days)	14.27	12.64	^Citation14
Antihistamines (for 6 weeks)	8.36	14.46	^Citation14

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty; RAST, radioallergosorbent test.

Figure 1 Expected probability of infants developing tolerance to cow’s milk by 18 months after starting a formula.

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG.

Table 2 Expected levels of health care resource use and corresponding costs at 2013–2014 prices over 18 months from starting a formula

	eHCF + LGG	eHCF alone	AAF
Mean resource use per patient
Number of visits to a general pediatrician	10.34	14.28	16.69
Number of visits to a pediatric specialist	0.89	0.96	1.00
Number of skin prick tests	0.05	0.05	0.05
Number of RASTs	0.43	0.60	0.70
Number of atopy patch tests	0.08	0.08	0.08
Number of oral food challenges	1.72	2.38	2.78
Mean NFZ cost of health service resource use per patient (PLN)
Pediatrician visits	29.92	32.16	33.53
Tests	4,680.21	6,465.85	7,551.84
Prescribed drugs	3.91	3.91	3.91
Formulas	979.12	1,246.56	16,744.12
Total	5,693.16	7,748.48	24,333.40
Mean parent cost per infant (PLN)
Pediatrician visits	0.0	0.0	0.0
Tests	23.52	28.64	31.75
Drugs	269.12	365.94	424.82
Formulas	699.61	831.53	358.76
Total	992.25	1,226.11	815.33

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty; RASTs, radioallergosorbent tests.

Table 3 Cost-effectiveness of eHCF + LGG versus eHCF alone and eHCF + LGG versus AAF

Formula	Expected cost per patient over 18 months	Expected probability of acquiring tolerance to cow’s milk by 18 months	Expected cost difference	Expected difference in probability of acquiring tolerance to cow’s milk	Additional cost for each additional infant acquiring tolerance to cow’s milk
From the NFZ’s perspective
eHCF + LGG	PLN 5,693	0.82			Dominant
eHCF alone	PLN 7,749	0.53	−PLN 2,056	0.29	Dominated
AAF	PLN 24,333	0.22	−PLN 18,640	0.60	Dominated
From the parents’ perspective
eHCF + LGG	PLN 992	0.82
eHCF alone	PLN 1,226	0.53	−PLN 234	0.29	Dominated
AAF	PLN 815	0.22	PLN 177	0.60	PLN 295

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty.

Table 4 Cost-effectiveness of eHCF + LGG versus eHCF alone and eHCF + LGG versus AAF, stratified by IgE status

Formula	Expected NFZ cost per patient over 18 months	Expected probability of acquiring tolerance to cow’s milk by 18 months	Expected NFZ cost difference	Expected difference in probability of acquiring tolerance to cow’s milk	Expected additional cost for each additional infant acquiring tolerance to cow’s milk
IgE-mediated CMA
eHCF + LGG	PLN 7,782	0.55			Dominant
eHCF alone	PLN 8,964	0.26	−PLN 1,182	0.29	Dominated
AAF	PLN 26,107	0.00	−PLN 18,325	0.55	Dominated
Non-IgE-mediated CMA
eHCF + LGG	PLN 4,997	0.91			Dominant
eHCF alone	PLN 7,343	0.62	−PLN 2,346	0.29	Dominated
AAF	PLN 23,742	0.30	−PLN 18,745	0.61	Dominated

Abbreviations: AAF, amino acid formula; CMA, cow’s milk allergy; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty.

Figure 2 Distribution of expected NFZ costs over 18 months from starting a formula and expected probability of developing tolerance to cow’s milk by 18 months, generated by 10,000 iterations of the model.

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty.

Figure 3 Distribution of expected parent costs over 18 months from starting a formula and expected probability of developing tolerance to cow’s milk by 18 months, generated by 10,000 iterations of the model.

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; PLN, Polish Zloty.

Figure 4 Probability of being cost-effective at different cost-effectiveness thresholds, from the NFZ’s perspective.

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; NFZ, Narodowy Fundusz Zdrowia; PLN, Polish Zloty.

Figure 5 Probability of being cost-effective at different cost-effectiveness thresholds, from the parents’ perspective.

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; LGG, Lactobacillus rhamnosus GG; PLN, Polish Zloty.

Table 5 Sensitivity analyses

Scenario	Formula	Range in expected probability of developing tolerance to cow’s milk	Range in expected costs to the NZF (PLN)	Range in expected parents’ costs (PLN)
The proportion of IgE-mediated allergic infants in the cohort ranges from 10% to 70% (base case value: 25%)	eHCF + LGG	0.88–0.66	5,300–6,900	900–1,200
	eHCF alone	0.58–0.37	7,500–8,500	1,100–1,300
	AAF	0.27–0.09	24,000–25,400	800–850
Assume no more infants develop tolerance to cow’s milk after 12 months	eHCF + LGG	0.82–0.79	Unchanged from baseline	Unchanged from baseline
	eHCF alone	0.53–0.40	Unchanged from baseline	Unchanged from baseline
	AAF	0.22–0.16	Unchanged from baseline	Unchanged from baseline
Assume no more infants develop tolerance to cow’s milk after 6 months	eHCF + LGG	0.82–0.48	5,700–6,900	1,000–1,000
	eHCF alone	0.53–0.22	7,700–8,400	1,100–1,300
	AAF	0.22–0.05	24,300–25,200	800–850
The number of follow-up visits to a pediatric specialist ranges from 50% below to 50% above the base case value	eHCF + LGG	Unchanged from baseline	Unchanged from baseline	Unchanged from baseline
	eHCF alone	Unchanged from baseline	Unchanged from baseline	Unchanged from baseline
	AAF	Unchanged from baseline	Unchanged from baseline	Unchanged from baseline
The number of diagnostic tests ranges from 50% below to 50% above the base case value	eHCF + LGG	Unchanged from baseline	3,400–8,000	1,000–1,000
	eHCF alone	Unchanged from baseline	4,500–11,000	1,100–1,300
	AAF	Unchanged from baseline	20,600–28,100	800–850
The number of prescribed drugs ranges from 50% below to 50% above the base case value	eHCF + LGG	Unchanged from baseline	Unchanged from baseline	790–1,300
	eHCF alone	Unchanged from baseline	Unchanged from baseline	860–1,600
	AAF	Unchanged from baseline	Unchanged from baseline	500–1,400

Abbreviations: AAF, amino acid formula; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; NZF, Narodowy Fundusz Zdrowia; PLN, Polish Zloty.

Zarządzenie Nr 79/2014/DSOZ. Prezesa Narodowego Funduszu Zdrowia Z Dnia 5 Grudnia 2014 R.

 Google Scholar

Reimbursement list 03/2015Polish Ministry of HealthPoland Available from: http://dziennikmz.mz.gov.pl/actdetails.html?year=2014&act=80

 Google Scholar

DOZ/Gemini Pharmacy Available from: http://www.doz.pl and http://www.aptekagemini.pl

 Google Scholar