Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK.
Authors: RR Taylor, E Sladkevicius, M Panca, G Lack, JF Guest
Source: Pediatric Allergy ad Immunology 2011; in press.
Abstract
Objective: To estimate the cost-effectiveness of using the extensively hydrolysed formula (eHF; Nutramigen) compared with an amino acid formula (AAF; Neocate) as first-line treatment for cow milk allergy (CMA) in the UK, from the perspective of the National Health Service (NHS).
Method: A decision model was constructed depicting the treatment paths and associated resource use attributable to first-line management of CMA with the two formulae. The model was based on the case records of 145 AAF-treated infants and 150 matched eHF-treated patients from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners (GPs) in the UK). The model estimated the costs and consequences of patient management over 12 months following their initial GP visit for CMA.
Results: Patients presenting with a combination of gastrointestinal symptoms and eczema accounted for 44% of all patients in both groups. Those with gastrointestinal symptoms alone and eczema alone accounted for up to a further 39% and 13% respectively. Those with urticaria and failure to thrive accounted for <5% and <6% of all patients respectively. Patients’ age and weight at presentation was a mean 2.6-2.8 months and 4.4kg respectively. It took a mean 2.2 months to start a formula after initially seeing a GP. Time to symptom resolution following the start of treatment was 1.2 months in both groups, hence the mean number of symptom-free months during the 12 months following the initial GP visit was estimated to be 8.6 months in both groups. Patients treated with an eHF had a mean 13.1 GP visits over the 12 months compared to 17.5 visits made by AAF-treated patients (p<0.001). The NHS cost of managing a CMA infant over the first 12 months following initial presentation to a GP was estimated to be £1,853 and £3,161 for an eHF-treated and AAF-treated patient respectively.
Conclusion: Starting treatment for CMA with an eHF was the cost-effective option, even though there were no significant differences in clinical outcomes between the two groups. A prospective, randomised controlled trial would allow a definitive confirmation of these findings.
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