Asia Pac Allergy.  2015 Apr;5(2):84-97. 10.5415/apallergy.2015.5.2.84.

Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants

• Bhanegaonkar AJ
• Horodniceanu EG
• Abdul Latiff AH
• Woodhull S
• Khoo PC
• Detzel P
• Ji X
• Botteman M

• KMID: 2397055
• DOI: http://doi.org/10.5415/apallergy.2015.5.2.84

Abstract

BACKGROUND
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).
OBJECTIVE
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.
METHODS
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).
RESULTS
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.
CONCLUSION
Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.

Keyword

Cost-benefit analysis; Dermatitis atopic; Infant formula

MeSH Terms

Breast Feeding
Cohort Studies
Cost-Benefit Analysis
Dermatitis, Atopic*
Diagnosis
Expert Testimony
Health Services Needs and Demand
Humans
Incidence
Income
Infant Formula*
Infant*
Milk
Parturition
Quality-Adjusted Life Years
Risk Reduction Behavior
United States
World Health Organization

Figure

• 

  Fig. 1 Simplified presentation of the model structure. Arrow key: Red is flare; Green is response; Yellow is no response. AD, atopic dermatitis; ADCS, atopic dermatitis controlled state; CMF, standard cow's milk formula; PHF-W, partially hydrolyzed whey formula. Infant cohorts enter the model at birth [A] and initiate a 17-week course of PHF-W or CMF [B]. If and when AD develops [C], 3 treatment approaches were possible: (1) Formula change only [D]: The child enters ADCS on first-line treatment formula in case of response within 2 weeks [G], or, in case of nonresponse, she/he is switched to a second treatment formula [H]. Patients from the ADCS [G], who were previously treated with first-line treatment formula [D], upon experiencing a flare, are treated in 1 of 3 ways: adding first-line pharmacotherapy [E], switching to second-line treatment formula [H], or switching to second-line treatment formula + drug 1 [K]. In case of response to second-line of treatment formula [H], patients entered ADCS [I]. In case of nonresponse to second-line treatment formula [H] or a flare in ADCS [I], a first-line pharmacotherapy (drug 1) would be added [J]. For simplicity, the model assumes response is achieved at this point and the patient enters ADCS on AD treatment second-line treatment formula [I]. (2) Formula change combined with first-line pharmacotherapy (switch to first-line treatment formula + drug 1) [E]: Pharmacotherapy would end in case of response and the child would enter ADCS on first-line treatment formula [G]. Otherwise, they would switch to second-line treatment formula while remaining on the same pharmacotherapy [K]. At this point, response would occur and they enter ADCS on second-line treatment formula [I]. (3) First-line pharmacotherapy only (drug 1 along with the initial formula) [F]: The child experiences a response and enters ADCS on the original formula [L]. Otherwise they remain on the initial formula and switch to a second- and third-line pharmacotherapy (drug 2 [M] and drug 3 [N]) until response occurs, at which point the patient enters ADCS on the original formula [L]. Patients from the ADCS [L], who were previously treated within the addition of first-line pharmacotherapy only [F], upon experiencing flare, were assumed to be treated by either a change in formula, pharmacotherapy, or both.

• 

  Fig. 2 Scatter plot of 5,000 simulations from multivariate probabilistic sensitivity analysis. MYR, Malaysian Ringgit; QALY, quality adjusted life-year.

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