Bhanegaonkar Abhijeet J, Horodniceanu Erica G, Abdul Latiff Amir Hamzah, Woodhull Sanjay, Khoo Phaik Choo, Detzel Patrick, Ji Xiang, Botteman Marc F
Pharmerit International, Bethesda, MD 20814, USA.
Department of Pediatrics, Pantai Hospital Kuala Lumpur, 59100 Kuala Lumpur, Malaysia.
Asia Pac Allergy. 2015 Apr;5(2):84-97. doi: 10.5415/apallergy.2015.5.2.84. Epub 2015 Apr 29.
Breastfeeding is best for infants and the World Health Organization recommends exclusive breastfeeding for at least the first 6 months of life. For those who are unable to be breastfed, previous studies demonstrate that feeding high-risk infants with hydrolyzed formulas instead of cow's milk formula (CMF) may decrease the risk of atopic dermatitis (AD).
To estimate the economic impact of feeding high-risk, not exclusively breastfed, urban Malaysian infants with partiallyhydrolyzed whey-based formula (PHF-W) instead of CMF for the first 17 weeks of life as an AD risk reduction strategy.
A cohort Markov model simulated the AD incidence and burden from birth to age 6 years in the target population fed with PHF-W vs. CMF. The model integrated published clinical and epidemiologic data, local cost data, and expert opinion. Modeled outcomes included AD-risk reduction, time spent post AD diagnosis, days without AD flare, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs are expressed in Malaysian Ringgit (MYR; MYR 1,000 = United States dollar [US $]316.50).
Feeding a high-risk infant PHF-W vs. CMF resulted in a 14% point reduction in AD risk (95% confidence interval [CI], 3%-23%), a 0.69-year (95% CI, 0.25-1.10) reduction in time spent post-AD diagnosis, additional 38 (95% CI, 2-94) days without AD flare, and an undiscounted gain of 0.041 (95% CI, 0.007-0.103) QALYs. The discounted AD-related 6-year cost estimates when feeding a high-risk infant with PHF-W were MYR 1,758 (US $556) (95% CI, MYR 917-3,033) and with CMF MYR 2,871 (US $909) (95% CI, MYR 1,697-4,278), resulting in a per-child net saving of MYR 1,113 (US $352) (95% CI, MYR 317-1,884) favoring PHF-W.
Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.
母乳喂养对婴儿最为有益，世界卫生组织建议在婴儿出生后的至少前6个月进行纯母乳喂养。对于那些无法进行母乳喂养的婴儿，先前的研究表明，用水解配方奶粉而非牛奶配方奶粉（CMF）喂养高危婴儿可能会降低患特应性皮炎（AD）的风险。
评估在马来西亚城市地区，用部分水解乳清蛋白配方奶粉（PHF-W）而非CMF喂养高危、非纯母乳喂养的婴儿，作为降低AD风险的策略，在出生后的前17周对经济产生的影响。
采用队列马尔可夫模型，模拟用PHF-W与CMF喂养目标人群时，从出生到6岁的AD发病率和负担情况。该模型整合了已发表的临床和流行病学数据、当地成本数据以及专家意见。模拟的结果包括AD风险降低、AD诊断后的时长、无AD发作的天数、质量调整生命年（QALY）以及成本（直接成本和间接成本）。结果按每年3%进行贴现。成本以马来西亚林吉特（MYR；1000林吉特 = 316.50美元）表示。
用PHF-W而非CMF喂养高危婴儿，AD风险降低了14个百分点（95%置信区间[CI]，3%-23%），AD诊断后的时长减少了0.69年（95%CI，0.25 - 1.10），无AD发作的天数增加了38天（95%CI，2 - 94），未贴现的QALY增加了0.041（95%CI，0.007 - 0.103）。用PHF-W喂养高危婴儿时，贴现后的6年AD相关成本估计为1758林吉特（556美元）（95%CI，917 - 3033林吉特），用CMF喂养时为2871林吉特（909美元）（95%CI，1697 - 4278林吉特），这使得每名儿童使用PHF-W可节省净成本1113林吉特（352美元）（95%CI，317 - 1884林吉特）。
在该人群中使用PHF-W而非CMF有望节省与AD相关的成本。
