title: Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany.
abstract: OBJECTIVE
  The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas.
  
  
  METHODS
  Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses.
  
  
  RESULTS
  The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses.
  
  
  CONCLUSIONS
  For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.
authors.affiliation: Institut für Gesundheitsökonomie und Klinische Epidemiologie, Cologne University, Cologne, Germany.
authors.forename: Janina
authors.initials: J
authors.lastname: Mertens
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.forename: Markus
authors.initials: M
authors.lastname: Lüngen
authors.forename: Andrea
authors.initials: A
authors.lastname: von Berg
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
authors.forename: Birgit
authors.initials: B
authors.lastname: Filipiak-Pittroff
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.forename: Armin
authors.initials: A
authors.lastname: Grübl
authors.forename: H-Erich
authors.initials: HE
authors.lastname: Wichmann
authors.forename: Carl-P
authors.initials: CP
authors.lastname: Bauer
authors.forename: Dietrich
authors.initials: D
authors.lastname: Reinhardt
authors.forename: Dietrich
authors.initials: D
authors.lastname: Berdel
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber
mesh_terms: D000041:Absenteeism; D000818:Animals; D002364:Caseins / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000178:diet therapy / Q000191:economics / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D041943:Infant Formula / Q000191:economics*; D007231:Infant, Newborn; D008297:Male; D008892:Milk / Q000009:adverse effects; D008894:Milk Proteins / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D011492:Protein Hydrolysates / Q000191:economics* / Q000627:therapeutic use; D012306:Risk; D000067816:Whey Proteins
chemical_list: D002364:Caseins; D008894:Milk Proteins; D011492:Protein Hydrolysates; D000067816:Whey Proteins