Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, UK.
Pediatr Allergy Immunol. 2012 May;23(3):240-9. doi: 10.1111/j.1399-3038.2011.01262.x. Epub 2012 Feb 23.
To estimate the cost-effectiveness of using an 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).
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.
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 faltering growth accounted for <5% and ≤6% of all patients, respectively. Patients' age and weight at presentation was a mean 2.6-2.8 months and 4.4 kg, 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 £1853 and £3161 for an eHF-treated and AAF-treated patient, respectively.
Starting treatment for CMA with an eHF was the cost-effective option, as there were no significant differences in clinical outcomes between the two groups. A prospective, randomized controlled trial would allow a definitive confirmation of these findings.
从英国国家医疗服务体系（NHS）的角度出发，评估使用深度水解配方（eHF；Nutramigen）与氨基酸配方（AAF；Neocate）作为牛奶过敏（CMA）一线治疗的成本效益。
构建决策模型，描述两种配方治疗 CMA 的一线管理路径和相关资源使用情况。该模型基于来自健康改善网络（THIN）数据库的 145 名 AAF 治疗婴儿和 150 名匹配的 eHF 治疗患者的病例记录[英国全科医生（GP）注册患者的全国代表性数据库]。该模型估计了患者在初次就诊后 12 个月内的管理成本和结果。
两组中胃肠道症状和湿疹并存的患者占所有患者的 44%。仅有胃肠道症状和仅有湿疹的患者分别占 39%和 13%。荨麻疹和生长不良的患者分别占所有患者的<5%和≤6%。患者就诊时的年龄和体重分别为 2.6-2.8 个月和 4.4 公斤。从最初看医生到开始使用配方需要平均 2.2 个月。两组中开始治疗后症状缓解的平均时间为 1.2 个月；因此，在初次就诊后的 12 个月内，无症状的平均月份数估计为两组中的 8.6 个月。在 12 个月内，接受 eHF 治疗的患者平均有 13.1 次 GP 就诊，而接受 AAF 治疗的患者则有 17.5 次就诊（p<0.001）。在初次就诊后的前 12 个月内，NHS 管理 CMA 婴儿的成本估计为 1853 英镑和 3161 英镑，分别为接受 eHF 治疗和 AAF 治疗的患者。
从 CMA 开始使用 eHF 治疗是一种具有成本效益的选择，因为两组在临床结果方面没有显著差异。一项前瞻性、随机对照试验将能够明确证实这些发现。
