PMID- 27799804
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1178-6981 (Print)
IS  - 1178-6981 (Electronic)
IS  - 1178-6981 (Linking)
VI  - 8
DP  - 2016
TI  - Relative cost-effectiveness of using an extensively hydrolyzed casein formula in 
      managing infants with cow's milk allergy in Brazil.
PG  - 629-639
AB  - OBJECTIVE: To estimate the cost-effectiveness of three alternative dietetic 
      strategies for cow's milk allergy in Brazil: 1) using an extensively hydrolyzed 
      casein formula (eHCF; Nutramigen) as a first-line formula, but switching to an 
      amino acid formula (AAF) if infants remain symptomatic; 2) using an AAF as a 
      first-line formula and then switching to an eHCF after 4 weeks once infants are 
      symptom-free, but switching back to an AAF if infants become symptomatic; and 3) 
      using an AAF as a first-line formula and keeping all infants on that formula. The 
      analysis was conducted from the perspective of the Brazilian public health care 
      system, Sistema Unico de Saude. 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 12 months from starting a formula. 
      The models also estimated the Sistema Unico de Saude cost (at 2013/2014 prices) 
      of managing infants over 12 months after starting a formula, as well as the 
      relative cost-effectiveness of each of the dietetic strategies. RESULTS: The 
      probability of developing tolerance to cow's milk by 12 months from starting a 
      formula was higher among infants with either IgE-mediated or non-IgE-mediated 
      allergy who were initially fed with an eHCF, compared with those who were 
      initially fed with an AAF. The total health care cost of initially feeding an 
      eHCF to cow's milk allergic infants was less than that of initially feeding both 
      IgE-mediated and non-IgE-mediated infants with an AAF. CONCLUSION: Within the 
      study's limitations, using an eHCF instead of an AAF for the first-line 
      management of newly-diagnosed infants with cow's milk allergy affords a 
      cost-effective use of publicly funded resources, since it improves the outcome 
      for less cost.
FAU - Guest, Julian F
AU  - Guest JF
AD  - Catalyst Health Economics Consultants, Northwood, Middlesex, UK; Faculty of Life 
      Sciences and Medicine, King's College, London, UK.
FAU - Yang, Ariana C
AU  - Yang AC
AD  - Universidade de Sao Paulo, Sao Paulo & Universidade Estadual de Campinas, Sao 
      Paulo, Brazil.
FAU - Oba, Jane
AU  - Oba J
AD  - Hospital Israelita Albert Einstein, Sao Paulo, Brazil & Hospital Municipal Menino 
      Jesus, Sao Paulo, Brazil.
FAU - Rodrigues, Maraci
AU  - Rodrigues M
AD  - Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao 
      Paulo, Brazil.
FAU - Caetano, Rosane
AU  - Caetano R
AD  - General Pediatrician, Rio de Janeiro, Brazil.
FAU - Polster, Lilian
AU  - Polster L
AD  - General Pediatrician, Sao Paulo, Brazil.
LA  - eng
PT  - Journal Article
DEP - 20161019
PL  - New Zealand
TA  - Clinicoecon Outcomes Res
JT  - ClinicoEconomics and outcomes research : CEOR
JID - 101560564
PMC - PMC5076537
OTO - NOTNLM
OT  - Brazil
OT  - amino acid formula
OT  - cost-effectiveness
OT  - cow's milk allergy
OT  - extensively hydrolyzed formula
COIS- DisclosureThis study was supported with an unrestricted research grant from Mead 
      Johnson Nutrition, Sao Paulo, Brazil. However, Mead Johnson Nutrition had no 
      influence on the study design; the collection, analysis, and interpretation of 
      data; the writing of the manuscript; or the decision to submit the manuscript for 
      publication. The views expressed in this article are those of the authors and not 
      necessarily those of Mead Johnson Nutrition. The authors have no further 
      conflicts of interest to disclose in this work.
EDAT- 2016/11/02 06:00
MHDA- 2016/11/02 06:01
PMCR- 2016/10/19
CRDT- 2016/11/02 06:00
PHST- 2016/11/02 06:00 [pubmed]
PHST- 2016/11/02 06:01 [medline]
PHST- 2016/11/02 06:00 [entrez]
PHST- 2016/10/19 00:00 [pmc-release]
AID - ceor-8-629 [pii]
AID - 10.2147/CEOR.S113448 [doi]
PST - epublish
SO  - Clinicoecon Outcomes Res. 2016 Oct 19;8:629-639. doi: 10.2147/CEOR.S113448. 
      eCollection 2016.