Budget impact of managing cow milk allergy in the Netherlands

Figures & data

Figure 1. Model depicting the management of cow milk allergy sufferers following initial presentation to a general practitioner or youth healthcare doctor. Numbers denote the probability of an infant following a particular path according to current practice. Note: eHF, extensively hydrolysed formula; AAF, amino acid formula; GP, general practitioner.

Table 1.  Unit resource costs at 2007/08 prices.

Resource	Unit cost (€) at 2007/08 prices
Amino acid formula (400 g can)	49.99
Blood test (radioallergosorbent test (RAST))	2.30
Consultation with general practitioner	18.00
Consultation with youth healthcare doctor	30.00
Consultation with youth healthcare nurse	23.00
Day-case at the hospital	127.97
Extensively hydrolysed formula (400 g can)	14.63
Follow-up consultation with general paediatrician	42.00
Initial consultation with general paediatrician	85.00
Outpatient visit with dietician	43.00
Outpatient visit with paediatric allergist	83.00
Outpatient visit with paediatric dermatologist	83.00
Outpatient visit with paediatric gastroenterologist	83.00
Outpatient visit with paediatric pulmonologist	67.00
Skin patch test	17.00
Skin prick test	17.00

Figure 2. Distribution between expected costs and time to symptom resolution (n=5,000 iterations of the model) for each cohort. eHF, extensively hydrolysed formula; AAF, amino acid formula; GP, General practitioner.

Table 2.  Expected levels of healthcare resource use attributable to managing 4,382 new cow milk allergy sufferers up to 1 year of age following initial consultation with a general practitioner or youth healthcare doctor.

Resource	Expected levels of healthcare resource use (95% confidence intervals) attributable to managing 4,382 new cow milk allergy sufferers up to 1 year of age following initial consultation with a general practitioner or youth healthcare doctor and managed according to
	Current practice	All cow milk allergy sufferers having a double-blind placebo-controlled cow milk challenge
Youth healthcare doctor visits	9,430 (6,740; 12,370)	9,430 (6,740; 12,370)
Youth healthcare nurse visits	7,070 (4,950; 9,240)	7,070 (4,950; 9,240)
General practitioner visits	6,280 (4,210; 8,570)	6,280 (4,210; 8,570)
General paediatrician visits	3,250 (2,020; 4,920)	10,610 (6,590; 16,050)
Paediatric allergist visits	200 (150; 260)	200 (150; 260)
Paediatric dermatologist visits	80 (60; 110)	80 (60; 110)
Paediatric gastroenterologist visits	40 (30; 50)	40 (30; 50)
Paediatric pulmonologist visits	40 (30; 50)	40 (30; 50)
Dietician visits	2,970 (2,770; 3,170)	2,970 (2,770; 3,170)
Day-case admissions	700 (490; 950)	8,760 (6,080; 11,830)

Table 3.  Expected cost (euros at 2007/2008 prices) of healthcare resource use (95% confidence intervals) attributable to managing 4,382 new cow milk allergy sufferers up to 1 year of age following initial consultation with a general practitioner or youth healthcare doctor.

Resource	Expected cost of healthcare resource use (95% confidence intervals) attributable to managing 4,382 new cow milk allergy sufferers up to 1 year of age following initial consultation with a general practitioner or youth healthcare doctor and managed according to
	Current practice		All cow milk allergy sufferers having a double-blind placebo-controlled cow milk challenge
	Expected cost (€)	Percent of total expected cost	Expected cost (€)	Percent of total expected cost
Extensively hydrolysed formula	8.08 (4.71; 11.28)	72	7.85 (4.57; 10.96)	70
Amino acid formula	2.17 (1.31; 3.45)	19	2.98 (1.80; 4.73)	27
Youth healthcare doctor visits	0.28 (0.23; 0.37)	3	0.28 (0.23; ; 0.37)	3
Youth healthcare nurse visits	0.16 (0.11; 0.22)	1	0.16 (0.11; 0.21)	1
General practitioner visits	0.11 (0.07; 0.15)	1	0.11 (0.07; 0.15)	1
Dietician visits	0.13 (0.12; 0.14)	1	0.13 (0.12; 0.14)	1
General paediatrician visits	0.15 (0.09; 0.22)	1	0.46 (0.29; 0.67)	4
Paediatric allergist visits	0.02 (0.01; 0.02)	<1	0.02 (0.01; 0.02)	<1
Paediatric dermatologist visits	0.01 (0.01; 0.01)	<1	0.01 (0.01; 0.01)	<1
Paediatric gastroenterologist visits	0.003 (0.002; 0.01)	<1	0.003 (0.002; 0.01)	<1
Paediatric pulmonologist visits	0.003 (0.002; 0.004)	<1	0.003 (0.002; 0.004)	<1
Elimination/provocation procedures	0.02 (0.01; 0.02)	<1	0.02 (0.01; 0.02)	<1
Day-case admissions	0.09 (0.06; 0.12)	1	1.12 (0.79; 1.50)	10
Other diagnostic procedures	0.01 (0.004; 0.008)	<1	0.01 (0.004; 0.008)	<1
TOTAL	11.28 (7.82; 14.33)	100	13.14 (9.15; 16.76)	100

Table 4.  Sensitivity analyses.

Scenario	Base-case value	Effect on current cost (€ millions) of managing 4,382 new cow milk allergy sufferers up to 1 year of age following initial consultation with a general practitioner or youth healthcare doctor
Number of general practitioner visits ranges from 1 to 4	1.4	The expected cost to healthcare insurers ranges from €11.13 to €11.45
Number of youth healthcare doctor visits ranges from 1 to 5	2.2	The expected cost to healthcare insurers ranges from €11.09 to €11.62
Unit cost of extensively hydrolysed formula ranges from €10.0 to €20.0	€14.63	The expected cost to healthcare insurers ranges from €8.68 to €14.21
Unit cost of amino acid formula ranges from €10.0 to €90.0	€44.99	The expected cost to healthcare insurers ranges from €9.5 to €12.99
Probability of having a double blind placebo controlled cow milk challenge ranges from 0 to 100%	8%	The expected cost to healthcare insurers ranges from €11.04 to €13.1
Probability of being intolerant to extensively hydrolysed formula ranges from 10 to 40%	29%	The expected cost to healthcare insurers ranges from €10.06 to €11.92
Probability of having the initial visit with a general practitioner ranges from 0 to 100%	38%	The expected cost to healthcare insurers ranges from €11.25 to €11.34

Figure 3. Sensitivity of the expected healthcare costs to changing the probability of having a double-blind placebo-controlled cow milk challenge. DBPCCMC, double-blind placebo-controlled cow milk challenge.