title: Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of using an extensively hydrolysed formula (eHF; Nutramigen) compared with an amino acid formula (AAF; Neocate) as first-line treatment for cow milk allergy (CMA) in the UK, from the perspective of the National Health Service (NHS).
  
  
  METHODS
  A decision model was constructed depicting the treatment paths and associated resource use attributable to first-line management of CMA with the two formulae. The model was based on the case records of 145 AAF-treated infants and 150 matched eHF-treated patients from The Health Improvement Network (THIN) database [a nationally representative database of patients registered with general practitioners (GPs) in the UK]. The model estimated the costs and consequences of patient management over 12 months following their initial GP visit for CMA.
  
  
  RESULTS
  Patients presenting with a combination of gastrointestinal symptoms and eczema accounted for 44% of all patients in both groups. Those with gastrointestinal symptoms alone and eczema alone accounted for up to a further 39% and 13%, respectively. Those with urticaria and faltering growth accounted for <5% and ≤6% of all patients, respectively. Patients' age and weight at presentation was a mean 2.6-2.8 months and 4.4 kg, respectively. It took a mean 2.2 months to start a formula after initially seeing a GP. Time to symptom resolution following the start of treatment was 1.2 months in both groups; hence, the mean number of symptom-free months during the 12 months following the initial GP visit was estimated to be 8.6 months in both groups. Patients treated with an eHF had a mean 13.1 GP visits over the 12 months compared to 17.5 visits made by AAF-treated patients (p < 0.001). The NHS cost of managing a CMA infant over the first 12 months following initial presentation to a GP was estimated to be £1853 and £3161 for an eHF-treated and AAF-treated patient, respectively.
  
  
  CONCLUSIONS
  Starting treatment for CMA with an eHF was the cost-effective option, as there were no significant differences in clinical outcomes between the two groups. A prospective, randomized controlled trial would allow a definitive confirmation of these findings.
authors.affiliation: Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, UK.
authors.forename: Riza R
authors.initials: RR
authors.lastname: Taylor
authors.forename: Erikas
authors.initials: E
authors.lastname: Sladkevicius
authors.forename: Monica
authors.initials: M
authors.lastname: Panca
authors.forename: Gideon
authors.initials: G
authors.lastname: Lack
authors.forename: Julian F
authors.initials: JF
authors.lastname: Guest
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage / Q000737:chemistry / Q000191:economics*; D000818:Animals; D002241:Carbohydrates / Q000008:administration & dosage / Q000737:chemistry / Q000191:economics*; D002417:Cattle; D003362:Cost-Benefit Analysis; D004041:Dietary Fats / Q000008:administration & dosage / Q000191:economics*; D005260:Female; D005526:Food, Formulated / Q000191:economics*; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000191:economics; D041943:Infant Formula / Q000737:chemistry / Q000191:economics*; D007231:Infant, Newborn; D008297:Male; D016269:Milk Hypersensitivity / Q000178:diet therapy* / Q000503:physiopathology; D011492:Protein Hydrolysates / Q000008:administration & dosage / Q000737:chemistry / Q000191:economics*; D006113:United Kingdom
chemical_list: D000596:Amino Acids; D002241:Carbohydrates; D004041:Dietary Fats; C076533:Neocate; D011492:Protein Hydrolysates