Guest Julian F, Weidlich Diana, Kaczmarski Maciej, Jarocka-Cyrta Elzbieta, Kobelska-Dubiel Natalia, Krauze Agnieszka, Sakowska-Maliszewska Iwona, Zawadzka-Krajewska Anna
Catalyst Health Economics Consultants, Northwood, Middlesex; Faculty of Life Sciences and Medicine, King's College, London, UK.
Catalyst Health Economics Consultants, Northwood, Middlesex.
Clinicoecon Outcomes Res. 2016 Jun 28;8:307-16. doi: 10.2147/CEOR.S105748. eCollection 2016.
To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as an initial treatment for cow's milk allergy compared with eHCF alone and amino acid formulas (AAF) in Poland from the perspective of the Polish National Health Fund (Narodowy Fundusz Zdrowia [NFZ]) and parents.
Decision modeling was used to estimate the probability of cow's milk allergic infants developing tolerance to cow's milk by 18 months. The model also estimated the cost to the NFZ and parents (Polish Zloty [PLN] at 2013-2014 prices) for managing infants over 18 months after starting one of the formulas as well as the relative cost-effectiveness of each of the formulas.
The probability of developing tolerance to cow's milk by 18 months was higher among infants who were fed eHCF + LGG (0.82) compared with those fed eHCF alone (0.53) or an AAF (0.22). An infant who is initially managed with eHCF + LGG is expected to consume fewer health care resources than infants managed with the other formulas. Hence, the estimated total health care cost incurred by the NFZ for initially feeding infants with eHCF + LGG (PLN 5,693) was less than that of feeding infants with eHCF alone (PLN 7,749) or an AAF (PLN 24,333). However, the total cost incurred by parents for initially feeding infants with an AAF (PLN 815) was marginally less than that of feeding with eHCF + LGG (PLN 993), which was less than that of feeding with eHCF alone (PLN 1,226).
Using eHCF + LGG instead of eHCF alone or an AAF for first-line management of newly diagnosed infants with cow's milk allergy affords a cost-effective use of NFZ-funded resources, since it improves outcome for less cost. Whether eHCF + LGG would be viewed as being cost-effective by parents is dependent on their willingness to pay an additional cost for additional tolerance acquisition to cow's milk.
从波兰国家卫生基金（Narodowy Fundusz Zdrowia [NFZ]）和家长的角度，评估与单独使用深度水解酪蛋白配方奶粉（eHCF）及氨基酸配方奶粉（AAF）相比，使用含益生菌鼠李糖乳杆菌GG的深度水解酪蛋白配方奶粉（eHCF + LGG；纽迪希亚LGG）作为牛奶过敏初始治疗方案的成本效益。
采用决策模型来估计牛奶过敏婴儿在18个月时对牛奶产生耐受的概率。该模型还估计了NFZ和家长（以2013 - 2014年价格计算的波兰兹罗提[PLN]）在开始使用其中一种配方奶粉后管理18个月以上婴儿的成本，以及每种配方奶粉的相对成本效益。
与单独喂食eHCF（0.53）或AAF（0.22）的婴儿相比，喂食eHCF + LGG的婴儿在18个月时对牛奶产生耐受的概率更高（0.82）。最初使用eHCF + LGG管理的婴儿预计比使用其他配方奶粉管理的婴儿消耗更少的医疗资源。因此，NFZ最初喂养婴儿使用eHCF + LGG产生的估计总医疗成本（5693波兰兹罗提）低于单独喂养婴儿使用eHCF（7749波兰兹罗提）或AAF（24333波兰兹罗提）。然而，家长最初喂养婴儿使用AAF产生的总成本（815波兰兹罗提）略低于使用eHCF + LGG（993波兰兹罗提），而使用eHCF + LGG又低于单独使用eHCF（1226波兰兹罗提）。
对于新诊断的牛奶过敏婴儿，使用eHCF + LGG而非单独使用eHCF或AAF进行一线管理可实现NFZ资助资源的成本效益利用，因为它能以更低成本改善治疗效果。eHCF + LGG是否被家长视为具有成本效益取决于他们是否愿意为获得额外的牛奶耐受性支付额外费用。
