title: Amino acid formula as a new strategy for diagnosing cow's milk allergy in infants: is it cost-effective?
abstract: OBJECTIVE
  To estimate the cost-effectiveness of a new strategy that uses an amino acid formula in the elimination diet of infants with suspected cow's milk allergy (CMA).
  
  
  METHODS
  This pharmacoeconomic study was developed from the perspective of the Brazilian Public Healthcare System. The new strategy proposes using an amino acid formula in the diagnostic elimination diet of infants (≤24 months) with suspected CMA. The rationale is that infants who do not respond to the amino acid formula do not suffer from CMA. Patients with a positive oral challenge test receive a therapeutic elimination diet based on Brazilian Food Allergy Guidelines. This approach was compared to the current recommendations of the Brazilian Food Allergy Guidelines. A decision model was constructed using TreeAge Pro 2012 software. Model inputs were based on a literature review and the opinions of a panel of experts. A univariate sensitivity analysis of incremental cost-effectiveness ratios was performed.
  
  
  RESULTS
  The mean cost per patient of the new amino acid formula strategy was R$3,341.57, while the cost of the current Brazilian guidelines strategy was R$3,641.08. The mean number of symptom-free days per patient, which was used as an indicator of effectiveness, was 900.6 and 875.7 days, respectively. The new strategy is, therefore, dominant. In the sensitivity analysis, the dominance was maintained with parameter variation.
  
  
  CONCLUSIONS
  In the absence of information in the literature, some premises were defined by a panel of specialists.
  
  
  CONCLUSIONS
  The new strategy, which uses an amino acid formula in the elimination diagnostic diet followed by an oral food challenge, is a dominant pharmacoeconomic approach that has a lower cost and results in an increased number of symptom-free days.
authors.affiliation: a Paulista School of Medicine , São Paulo , Brazil.
authors.forename: Mauro Batista de
authors.initials: MB
authors.lastname: Morais
authors.affiliation: b School of Medicine - Pontifical University of Rio Grande do Sul (PUCRS) , Porto Alegre , Brazil.|c Hospital Moinhos de Vento , Porto Alegre , RS , Brazil.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Spolidoro
authors.affiliation: d School of Medicine - Pontifical University of Paraná (PUCPR) , Curitiba , Brazil.|e Hospital Pequeno Príncipe, Curitiba , Brazil.
authors.forename: Mário César
authors.initials: MC
authors.lastname: Vieira
authors.affiliation: f Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo , São Paulo , Brazil.
authors.forename: Ary Lopes
authors.initials: AL
authors.lastname: Cardoso
authors.affiliation: g Evidencias - a Kantar Health Company, Campinas , Brazil.
authors.forename: Otavio
authors.initials: O
authors.lastname: Clark
authors.affiliation: g Evidencias - a Kantar Health Company, Campinas , Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Nishikawa
authors.affiliation: f Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo , São Paulo , Brazil.
authors.forename: Ana Paula Moschione
authors.initials: AP
authors.lastname: Castro
mesh_terms: D000596:Amino Acids; D000818:Animals; D001938:Brazil; D002417:Cattle; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003938:Diagnostic Techniques, Digestive System / Q000191:economics*; D017850:Economics, Pharmaceutical; D006801:Humans; D007223:Infant; D016269:Milk Hypersensitivity / Q000175:diagnosis*; D012680:Sensitivity and Specificity
chemical_list: D000596:Amino Acids
keywords: Cost-effectiveness evaluation; Health economics; diagnosis; infant formula; milk hypersensitivity