Cost-effectiveness of using an extensively hydrolyzed casein formula plus the probiotic Lactobacillus rhamnosus GG compared to an extensively hydrolyzed formula alone or an amino acid formula as first-line dietary management for cow’s milk allergy in the US

Figures & data

Figure 1 Time to successful management of cow’s milk allergy.

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

Table 1 Mean cow’s milk allergy-related health care resource use per infant over the study period

	eHCF group	eHCF + LGG group	AAF group
Number of infants	136	59	217
Mean number per infant
Outpatient visits to see a physician	2.16±1.39*	3.24±0.56*	8.88±1.05*
Diagnostic and laboratory tests	4.20±0.76**	4.68±1.18**	8.22±0.57**
Hospital admissions	0.01±0.01	0.02±0.02	0.01±0.01
Percentage of infants who received
Gastrointestinal drugs	41%***	41%***	59%***
Topical preparations	23%	9%	15%
Antihistamines	0%	0%	1%
Adrenalin	5%	2%	9%

Notes: Values are shown as mean ± standard error.

* The AAF group is significantly different from the other two; P=0.001.

** The AAF group is significantly different from the other two; P=0.001.

*** The AAF group is significantly different from the other two; P=0.002.

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

Table 2 Cost of infant management (in US $ at 2012 prices)

	eHCF group			eHCF + LGG group			AAF group
	Parent cost per infant	Insurer cost per infant	Total cost per infant	Parent cost per infant	Insurer cost per infant	Total cost per infant	Parent cost per infant	Insurer cost per infant	Total cost per infant
Outpatient visits to see a physician	$72.08	$465.92	$538.00	$51.69	$420.66	$472.35	$178.30	$1,196.21	$1,374.51
eHCF	$203.14	$2,387.06	$2,590.20
eHCF + LGG				$168.15	$2,344.55	$2,512.70
AAF	$6.14	$227.97	$234.11	$1.69	$193.91	$195.60	$335.42	$3,853.12	$4,188.54
Other prescriptions	$66.27	$304.43	$370.70	$53.28	$285.54	$338.82	$105.28	$500.72	$606.00
Hospitalization	$0.00	$48.29	$48.29	$3.67	$53.81	$57.48	$8.35	$78.22	$86.57
Total	$347.63	$3,433.67	$3,781.30	$278.48	$3,298.47	$3,576.95	$627.35	$5,628.27	$6,255.62

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

Figure 2 Distribution of insurers’ costs and time to being successfully managed, generated by bootstrapping.

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

Table 3 Sensitivity analyses

Scenario	eHCF-fed versus eHCF + LGG-fed infants		AAF-fed versus eHCF-fed infants
	Parents’ perspective	Insurers’ perspective	Parents’ perspective	Insurers’ perspective
The difference in the number of outpatient visits between the groups ranges from 0 to 10 visits per infant	$50–$240 per infant	$90–$500 per infant	$170–$340 per infant	$1,500–$2,600 per infant
The difference in the cash value of formulas to insurers between the groups ranges from $10 to $400 per infant		$130–$520 per infant		$2,000–$2,400 per infant
The difference in the cash value of formulas to parents between the groups ranges from $10 to $100 per infant	$70–$160 per infant		$250–$340 per infant

Notes: Differences in mean costs per infant between alternative formulas from parents’ and insurers’ perspectives.

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