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 Spain

Figures & data

Table 1 Unit costs in Euros at 2012/2013 prices

Resource use	Unit cost (€)
Visits
Initial pediatrician visit	62.24
Follow-up pediatrician visit	43.37
Initial pediatric specialist visit	133.68
Follow-up pediatric specialist visit	71.30
Tests
Skin prick test	95.08
Radioallergosorbent test (RAST)	29.86
Atopy test	18.55
Food challenge	95.08
Special formulae
eHCF (per 400 g can)	25.90
eHCF + LGG (per 400 g can)	27.50
AAF (per 400 g can)	39.90
Prescribed medication
Emollients (per month)	24.13
Corticosteroids (for 7 days)	4.29
Antihistamines (for 7 days)	3.72

Note: Data from Ministerio de Sanidad, Servicios Sociales e Igualdad. https://www.msssi.gob.es.¹¹

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

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

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

Table 2 Expected levels of health care resource use and corresponding costs in Euros at 2012/2013 prices over 18 months from starting a formula

	eHCF + LGG		eHCF		AAF
	IgE-mediated	Non–IgE-mediated	IgE-mediated	Non–IgE-mediated	IgE-mediated	Non–IgE-mediated
Mean resource use per patient
Number of visits to a pediatrician	10.42	9.17	12.23	10.59	13.59	11.73
Number of visits to a pediatric specialist	4.61	3.79	5.32	4.63	5.83	5.31
Number of skin prick tests	2.40	1.71	3.00	2.40	3.44	2.95
Number of RAST	2.20	1.57	2.74	2.20	3.15	2.70
Number of atopy tests	0.25	0.25	0.25	0.25	0.25	0.25
Number of oral food challenges	2.05	1.46	2.56	2.05	2.94	2.52
Mean cost of health service resource use per patient (€)
Pediatrician visits	471.12	416.95	549.47	478.61	608.84	528.18
Pediatric specialist visits	391.16	332.82	441.71	392.59	478.34	441.03
Tests	493.47	353.17	614.60	493.53	705.23	605.22
Prescribed drugs	81.36	69.89	91.39	82.31	98.08	92.83
Prescribed formula	2,382.71	1,800.83	2,714.76	2,273.91	4,727.07	4,143.48
Total	3,819.82	2,973.66	4,411.93	3,720.95	6,617.56	5,810.74

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

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

	Expected SNS cost per patient over 18 months	Expected probability of acquiring tolerance to cow’s milk by 18 months	Expected SNS cost-difference	Expected difference in probability of acquiring tolerance to cow’s milk	Incremental cost for each additional infant acquiring tolerance to cow’s milk
IgE-mediated infants
eHCF + LGG	€3,820	0.55	−€592	0.29	Dominant
eHCF	€4,412	0.26	−€2,206	0.26	Dominant
AAF	€6,618	0.00
Non–IgE-mediated infants
eHCF + LGG	€2,974	0.91	−€747	0.29	Dominant
eHCF	€3,721	0.62	−€2,090	0.32	Dominant
AAF	€5,811	0.30

Abbreviations: AAF, amino acid formulae; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; SNS, Spanish National Health Service.

Figure 2 (A) Distribution of expected SNS costs over 18 months from starting a formula and expected probability of developing tolerance to cow’s milk by 18 months among IgE-mediated allergic infants, generated by 10,000 iterations of the model. (B) Distribution of expected SNS costs over 18 months from starting a formula and expected probability of developing tolerance to cow’s milk by 18 months among non–IgE-mediated allergic infants, generated by 10,000 iterations of the model.

Abbreviations: AAF, amino acid formulae; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; SNS, Spanish National Health Service.

Figure 3 (A) Probability of being cost-effective at different cost-effectiveness thresholds for IgE-mediated allergic infants, from the perspective of the SNS. (B) Probability of being cost-effective at different cost-effectiveness thresholds for non–IgE-mediated allergic infants, from the perspective of the SNS.

Abbreviations: AAF, amino acid formulae; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; SNS, Spanish National Health Service.

Table 4 Deterministic sensitivity analyses

Scenario	Formula	Range in expected probability of developing tolerance to cow’s milk		Range in expected SNS cost per patient
		IgE-mediated	Non–IgE-mediated	IgE-mediated	Non–IgE-mediated
Assume no more infants develop tolerance to cow’s milk after 12 months	eHCF + LGG	0.55–0.50	0.90–0.85	Unchanged from baseline	Unchanged from baseline
	eHCF	0.25–0.20	0.60–0.55	Unchanged from baseline	Unchanged from baseline
	AAF	0.00–0.00	0.30–0.25	Unchanged from baseline	Unchanged from baseline
Assume no incremental improvement after 6 months and no more infants develop tolerance to cow’s milk after 12 months	eHCF + LGG	0.55–0.45	Unchanged from baseline	Unchanged from baseline	Unchanged from baseline
	eHCF	0.25–0.15	0.60–0.50	Unchanged from baseline	Unchanged from baseline
	AAF	0.00–0.00	0.30–0.20	Unchanged from baseline	Unchanged from baseline
The number of follow-up visits to a pediatrician ranges from 50% below to 50% above the base case value	eHCF + LGG	Unchanged from baseline	Unchanged from baseline	€3,600–4,000	€2,700–3,200
	eHCF	Unchanged from baseline	Unchanged from baseline	€4,100–4,700	€3,500–4,000
	AAF	Unchanged from baseline	Unchanged from baseline	€6,300–6,900	€5,500–6,100
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	€3,600–4,000	€2,800–3,100
	eHCF	Unchanged from baseline	Unchanged from baseline	€4,200–4,600	€3,600–3,900
	AAF	Unchanged from	Unchanged from baseline	€6,400–6,800	€5,600–6,000
The number of diagnostic tests ranges from 50% below to 50% above the base case value	eHCF + LGG	Unchanged from baseline	Unchanged from baseline	€3,600–4,000	€2,800–3,100
	eHCF	Unchanged from baseline	Unchanged from baseline	€4,200–4,700	€3,500–3,900
	AAF	Unchanged from baseline	Unchanged from baseline	€6,300–6,900	€5,500–6,000

Abbreviations: AAF, amino acid formulae; eHCF, extensively hydrolyzed casein formula; IgE, immunoglobulin E; LGG, Lactobacillus rhamnosus GG; SNS, Spanish National Health Service.

Ministerio de Sanidad, Servicios Sociales e Igualdad Available from: https://www.msssi.gob.es

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