Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany

Pediatr Allergy Immunol. 2012 Sep;23(6):597-604. doi: 10.1111/j.1399-3038.2012.01304.x. Epub 2012 May 25.

Abstract

Objective: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas.

Patients and methods: Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses.

Results: The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses.

Conclusions: For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Absenteeism
  • Animals
  • Caseins / economics
  • Caseins / therapeutic use
  • Child
  • Child, Preschool
  • Dermatitis, Atopic / diet therapy
  • Dermatitis, Atopic / economics
  • Dermatitis, Atopic / prevention & control*
  • Double-Blind Method
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant Formula / economics*
  • Infant, Newborn
  • Male
  • Milk / adverse effects
  • Milk Proteins / economics
  • Milk Proteins / therapeutic use
  • Prevalence
  • Protein Hydrolysates / economics*
  • Protein Hydrolysates / therapeutic use
  • Risk
  • Whey Proteins

Substances

  • Caseins
  • Milk Proteins
  • Protein Hydrolysates
  • Whey Proteins