CATALYST Health Economics Consultants, 34b High Street, Northwood, UK.
J Med Econ. 2010;13(2):257-72. doi: 10.3111/13696998.2010.482904.
To quantify the health economic impact of managing cow milk allergy (CMA) in South Africa, from the perspective of healthcare insurers in both the private and public sectors and parents/carers of CMA sufferers.
A decision model depicting the management of CMA in South Africa was constructed, using information obtained from interviews with paediatric specialists in the private and public sectors with relevant clinical experience. The model was used to estimate the expected 12-monthly levels of healthcare resource use and corresponding costs (at 2007/08 prices) attributable to managing CMA sufferers following an initial consultation with a paediatrician.
The expected 12-monthly cost incurred by an insurer attributable to managing a CMA sufferer following an initial consultation with a paediatrician was estimated to be R2,430.4 (€202.0) and R1,073.7 (€89.0) in the private and public sector, respectively. The expected 12-monthly cost incurred by parents/carers following an initial consultation with a paediatrician was estimated to be R43,563.1 (€3,634.0) and R24,899.9 (€2,076.9) in the private and public sector, respectively. The time taken for a CMA sufferer to be put on an appropriate diet and achieve symptom resolution was estimated to be 24 days in the private sector and 18 days in the public sector. The total cost to manage an annual cohort of 18,270 newly diagnosed infants with CMA in South Africa in the first year following presentation to a paediatrician was estimated to be R22.1 (€1.8) million for healthcare insurers and R489.1 (€40.8) million for parents/carers. The expected costs to insurers were driven by visits to general paediatricians and prescriptions for dermatological drugs in both the private and public sectors. The expected costs to parents/carers were driven by over-the-counter (OTC) purchases of clinical nutrition preparations.
The intolerance rates were derived from a study among 1,000 infants with CMA in the UK, healthcare resource use was not collected prospectively and the study period was limited to 1 year following presentation to a paediatrician and does not consider the impact of CMA in subsequent years. However, most children outgrow this form of allergy by the time they reach 2 years of age.
CMA imposes a substantial socio-economic burden in South Africa, especially on parents/carers of CMA sufferers. Any strategy that reduces this burden should potentially lead to higher compliance with clinicians' recommendations, thereby improving health outcomes associated with treatment and should also release healthcare resource use for alternative use.
从南非私营和公共部门医疗保险公司以及牛奶过敏（CMA）患者家长/照顾者的角度出发，定量评估管理牛奶过敏的卫生经济学影响。
利用具有相关临床经验的私营和公共部门儿科专家访谈获得的信息，构建了南非管理 CMA 的决策模型。该模型用于估算在儿科医生首次就诊后，管理 CMA 患者的预期 12 个月医疗资源使用水平和相应费用（按 2007/08 年价格计算）。
私营部门和公共部门中，保险公司管理一名 CMA 患者在儿科医生首次就诊后 12 个月的预期费用分别为 2430.4 南非兰特（202.0 欧元）和 1073.7 南非兰特（89.0 欧元）。父母/照顾者在儿科医生首次就诊后 12 个月的预期费用分别为 43563.1 南非兰特（3634.0 欧元）和 24899.9 南非兰特（2076.9 欧元）。CMA 患者接受适当饮食并症状缓解的时间估计为私营部门 24 天，公共部门 18 天。在儿科医生首次就诊后第一年，管理南非 18270 例新诊断为 CMA 的婴儿的年度队列，预计医疗保险公司的总成本为 221 万南非兰特（18.1 万欧元），父母/照顾者的总成本为 4891 万南非兰特（408.1 万欧元）。私营部门和公共部门中，保险公司的预期成本由普通儿科医生就诊次数和皮肤科药物处方所驱动。父母/照顾者的预期成本由非处方（OTC）购买临床营养制剂所驱动。
不耐受率是从英国 1000 例 CMA 婴儿的研究中得出的，医疗资源使用没有前瞻性收集，研究期间仅限于儿科医生就诊后 1 年，不考虑 CMA 在随后几年的影响。然而，大多数儿童在 2 岁时就会摆脱这种过敏。
CMA 在南非造成了巨大的社会经济负担，特别是对 CMA 患者的父母/照顾者而言。任何减轻这种负担的策略都有可能提高临床医生建议的遵从性，从而改善与治疗相关的健康结果，并释放医疗资源用于替代用途。
