Mauro Batista de Morais1, José Vicente Spolidoro2,3, Mário César Vieira4,5, Ary Lopes Cardoso6, Otavio Clark7, Alvaro Nishikawa7, Ana Paula Moschione Castro6. 1. a Paulista School of Medicine , São Paulo , Brazil. 2. b School of Medicine - Pontifical University of Rio Grande do Sul (PUCRS) , Porto Alegre , Brazil. 3. c Hospital Moinhos de Vento , Porto Alegre , RS , Brazil. 4. d School of Medicine - Pontifical University of Paraná (PUCPR) , Curitiba , Brazil. 5. e Hospital Pequeno Príncipe, Curitiba , Brazil. 6. f Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo , São Paulo , Brazil. 7. g Evidencias - a Kantar Health Company, Campinas , Brazil.
Abstract
AIMS: 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). MATERIALS AND 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. LIMITATIONS: 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.
AIMS: 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). MATERIALS AND 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. LIMITATIONS: 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.
Entities:
Keywords:
Cost-effectiveness evaluation; Health economics; diagnosis; infant formula; milk hypersensitivity
Authors: Carina Venter; Trevor Brown; Rosan Meyer; Joanne Walsh; Neil Shah; Anna Nowak-Węgrzyn; Tong-Xin Chen; David M Fleischer; Ralf G Heine; Michael Levin; Mario C Vieira; Adam T Fox Journal: Clin Transl Allergy Date: 2017-08-23 Impact factor: 5.871