Guest Julian F, Yang Ariana C, Oba Jane, Rodrigues Maraci, Caetano Rosane, Polster Lilian
Catalyst Health Economics Consultants, Northwood, Middlesex, UK; Faculty of Life Sciences and Medicine, King's College, London, UK.
Universidade de São Paulo, São Paulo & Universidade Estadual de Campinas, São Paulo, Brazil.
Clinicoecon Outcomes Res. 2016 Oct 19;8:629-639. doi: 10.2147/CEOR.S113448. eCollection 2016.
To estimate the cost-effectiveness of three alternative dietetic strategies for cow's milk allergy in Brazil: 1) using an extensively hydrolyzed casein formula (eHCF; Nutramigen) as a first-line formula, but switching to an amino acid formula (AAF) if infants remain symptomatic; 2) using an AAF as a first-line formula and then switching to an eHCF after 4 weeks once infants are symptom-free, but switching back to an AAF if infants become symptomatic; and 3) using an AAF as a first-line formula and keeping all infants on that formula. The analysis was conducted from the perspective of the Brazilian public health care system, Sistema Único de Saude.
Decision modeling was used to estimate the probability of immunoglobulin E (IgE)-mediated and non-IgE-mediated allergic infants developing tolerance to cow's milk by 12 months from starting a formula. The models also estimated the Sistema Único de Saude cost (at 2013/2014 prices) of managing infants over 12 months after starting a formula, as well as the relative cost-effectiveness of each of the dietetic strategies.
The probability of developing tolerance to cow's milk by 12 months from starting a formula was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were initially fed with an eHCF, compared with those who were initially fed with an AAF. The total health care cost of initially feeding an eHCF to cow's milk allergic infants was less than that of initially feeding both IgE-mediated and non-IgE-mediated infants with an AAF.
Within the study's limitations, using an eHCF instead of an AAF for the first-line management of newly-diagnosed infants with cow's milk allergy affords a cost-effective use of publicly funded resources, since it improves the outcome for less cost.
评估巴西针对牛奶过敏的三种替代饮食策略的成本效益：1）使用深度水解酪蛋白配方奶粉（eHCF；纽康特）作为一线配方奶粉，但如果婴儿仍有症状则改用氨基酸配方奶粉（AAF）；2）使用AAF作为一线配方奶粉，婴儿无症状4周后改用eHCF，但如果婴儿再次出现症状则换回AAF；3）使用AAF作为一线配方奶粉并让所有婴儿持续使用该配方奶粉。该分析是从巴西公共卫生保健系统即单一卫生系统（Sistema Único de Saude）的角度进行的。
采用决策模型来估计免疫球蛋白E（IgE）介导和非IgE介导的过敏婴儿从开始使用配方奶粉起12个月内对牛奶产生耐受的概率。这些模型还估计了从开始使用配方奶粉起12个月内管理婴儿的单一卫生系统成本（按2013/2014年价格），以及每种饮食策略的相对成本效益。
与最初喂食AAF的婴儿相比，最初喂食eHCF的IgE介导或非IgE介导过敏婴儿从开始使用配方奶粉起12个月内对牛奶产生耐受的概率更高。给牛奶过敏婴儿最初喂食eHCF的总医疗保健成本低于给IgE介导和非IgE介导婴儿最初喂食AAF的成本。
在研究的局限性范围内，对于新诊断的牛奶过敏婴儿，使用eHCF而非AAF进行一线管理可有效利用公共资金资源，因为它能以更低成本改善治疗效果。
