title: Relative cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow's milk allergy in Spain.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as a first-line management for cow's milk allergy compared with eHCF alone, and amino acid formulae in Spain, from the perspective of the Spanish National Health Service (SNS).
  
  
  METHODS
  Decision modeling was used to estimate the probability of immunoglobulin E (IgE)-mediated and non-IgE-mediated allergic infants developing tolerance to cow's milk by 18 months. The models also estimated the SNS cost (at 2012/2013 prices) of managing infants over 18 months after starting a formula as well as the relative cost-effectiveness of each of the formulae.
  
  
  RESULTS
  The probability of developing tolerance to cow's milk by 18 months was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were fed eHCF + LGG compared with those fed one of the other formulae. The total health care cost of initially feeding infants with eHCF + LGG was less than that of feeding infants with one of the other formulae. Hence, eHCF + LGG affords the greatest value for money to the SNS for managing both IgE-mediated and non-IgE-mediated cow's milk allergy.
  
  
  CONCLUSIONS
  Using eHCF + LGG instead of eHCF alone or amino acid formulae for first-line management of newly-diagnosed infants with cow's milk allergy affords a cost-effective use of publicly funded resources because it improves outcome for less cost. A randomized controlled study showing faster tolerance development in children receiving a probiotic-containing formula is required before this conclusion can be confirmed.
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK ; Faculty of Life Sciences and Medicine, King's College, London, UK.
authors.forename: Julian F
authors.initials: JF
authors.lastname: Guest
authors.affiliation: Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Weidlich
authors.affiliation: Centro de Salud de Paterna, Valencia, Spain.
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Mascuñan Díaz
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Díaz
authors.affiliation: Clínica de Asma y Alergia Doctores Ojeda, Valencia, Spain.
authors.forename: Pedro Manuel
authors.initials: PM
authors.lastname: Ojeda
authors.affiliation: Hospital General de Requena, Valencia, Spain.
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Ferrer-González
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Gil
authors.affiliation: Centro de Salud Valle de la Oliva, Majadahonda, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Onrubia
authors.affiliation: Centro de Salud la Chopera, Alcobendas, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Rincón Victor
keywords: Lactobacillus rhamnosus GG; Spain; amino acid formula; cost-effectiveness; cow’s milk allergy; extensively hydrolyzed formula