Suratannon Narissara, Prapansilp Panote, Srinarongsook Athitaya, Tanpowpong Pornthep, Chatchatee Pantipa, Pongpirul Krit
Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Front Nutr. 2023 Jun 6;10:1099462. doi: 10.3389/fnut.2023.1099462. eCollection 2023.
Cow's milk protein allergy (CMPA) is children's most common food allergy. Therapeutic infant formulas for CMPA lead to symptom-free and potentially benefit early tolerance induction and reducing the allergic march in non-breastfed babies. This study assessed the cost-effectiveness of CMPA management with different therapeutic infant formulas in Thailand, which may reflect situations in developing countries throughout Asia. An analytic decision model was developed to simulate the occurrence of eczema, urticaria, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA over 36 months. Extensively hydrolyzed casein formula with added probiotic (previously ) strain GG (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), soy protein-based formula (SPF), and amino acid formula (AAF) were compared from the healthcare payer perspective. The results from a prospective cohort study were used for comparative effectiveness measures, while local experts were interviewed to estimate the healthcare resource used in the management of CMPA. The costs of healthcare resources were obtained from standard, publicly available sources. The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881). Compared with other formulas, EHCF+LGG was expected to save USD 370 (SPF), USD 1,071 (EHWF), and USD 6,161 (AAF) in the total cost of CMPA management over 36 months. In conclusion, EHCF+LGG was the most cost-effective strategy for managing non-breastfed infants with CMPA. This strategy was associated with more children developing immune tolerance to cow's milk and being symptom-free, contributing to overall cost-saving potential.
牛奶蛋白过敏（CMPA）是儿童最常见的食物过敏。用于CMPA的治疗性婴儿配方奶粉可使症状消失，并可能有助于早期诱导耐受，减少非母乳喂养婴儿的过敏进程。本研究评估了在泰国使用不同治疗性婴儿配方奶粉管理CMPA的成本效益，这可能反映了亚洲发展中国家的情况。开发了一个分析决策模型，以模拟CMPA婴儿在36个月内发生湿疹、荨麻疹、哮喘、鼻结膜炎或无症状的情况。从医疗保健支付方的角度比较了添加益生菌（先前的）菌株GG的深度水解酪蛋白配方奶粉（EHCF+LGG）、深度水解乳清配方奶粉（EHWF）、大豆蛋白基配方奶粉（SPF）和氨基酸配方奶粉（AAF）。前瞻性队列研究的结果用于比较有效性测量，同时采访当地专家以估计CMPA管理中使用的医疗资源。医疗资源成本来自标准的公开可用来源。CMPA管理的直接医疗成本中，EHCF+LGG最低（1720美元），其次是SPF（2090美元）、EHWF（2791美元）和AAF（7881美元）。与其他配方奶粉相比，预计EHCF+LGG在36个月的CMPA管理总成本中可节省370美元（SPF）、1071美元（EHWF）和6161美元（AAF）。总之，EHCF+LGG是管理非母乳喂养CMPA婴儿最具成本效益的策略。该策略与更多儿童对牛奶产生免疫耐受且无症状相关，有助于总体节省成本。
