Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management

Narissara Suratannon; Panote Prapansilp; Athitaya Srinarongsook; Pornthep Tanpowpong; Pantipa Chatchatee; Krit Pongpirul

doi:10.3389/fnut.2023.1099462

Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management

Front Nutr. 2023 Jun 6:10:1099462. doi: 10.3389/fnut.2023.1099462. eCollection 2023.

Authors

Narissara Suratannon^{1

2}, Panote Prapansilp³, Athitaya Srinarongsook³, Pornthep Tanpowpong⁴, Pantipa Chatchatee^{1

2}, Krit Pongpirul^{5

6}

Affiliations

¹ Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
³ Medical Sciences, Reckitt | Mead Johnson Nutrition, Bangkok, Thailand.
⁴ Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
⁵ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
⁶ Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

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 Lacticaseibacillus rhamnosus (previously Lactobacillus rhamnosus) 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.

Keywords: allergy; asthma; atopic dermatitis; atopic disease; cow's milk protein allergy; infant formula; rhinitis.

Grants and funding

This research was funded by Reckitt | Mead Johnson Nutrition, Thailand. The funder had no role in the design of the study, whereas the data collection, data analysis, and economic modeling were performed by IQVIA Thailand with minimal intervention from the funder. The decision to publish the results was made by the key opinion leaders.