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


CONCLUSIONS
Using PHF-W instead of CMF in this population is expected to result in AD-related costs savings.
Pharmerit International, Bethesda, MD 20814, USA.
Abhijeet J
AJ
Bhanegaonkar
Pharmerit International, Bethesda, MD 20814, USA.
Erica G
EG
Horodniceanu
Department of Pediatrics, Pantai Hospital Kuala Lumpur, 59100 Kuala Lumpur, Malaysia.
Amir Hamzah
AH
Abdul Latiff
Department of Pediatrics, Ramsay Sime Darby, Subang Jaya Medical Centre, 47500 Subang Jaya, Malaysia.
Sanjay
S
Woodhull
Department of Pediatrics, Ramsay Sime Darby, Subang Jaya Medical Centre, 47500 Subang Jaya, Malaysia.
Phaik Choo
PC
Khoo
Nestlé Research Center, 1000 Lausanne 26, Switzerland.
Patrick
P
Detzel
Pharmerit International, Bethesda, MD 20814, USA.
Xiang
X
Ji
Pharmerit International, Bethesda, MD 20814, USA.
Marc F
MF
Botteman
Cost-benefit analysis; Dermatitis atopic; Infant formula