RESUMEN
OBJECTIVE: To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) compared with an eHCF alone and an amino acid formula (AAF) in treating cow's milk allergy (CMA) in the US, from the perspective of third-party insurers and from parents. METHODS: A decision model was used to estimate the probability of cow's milk allergic infants developing tolerance to cow's milk by 18 months. The model also estimated the cost to insurers and parents (US dollars at 2016 prices) of managing infants over 18 months after starting one of the formulae, as well as the relative cost-effectiveness of each of the formulae. RESULTS: The probability of developing tolerance to cow's milk was higher among infants who were fed eHCF + LGG compared with those fed an eHCF alone or an AAF. Infants who are initially fed with eHCF + LGG are expected to utilize fewer healthcare resources than those fed with one of the other formulae. Hence, the estimated total healthcare cost incurred by third-party insurers and parents of initially feeding infants with eHCF + LGG was less than that of feeding infants with an eHCF alone or an AAF. CONCLUSION: Initial management of newly-diagnosed cow's milk allergic infants with eHCF + LGG was found to afford a cost-effective strategy to both third-party insurers and parents when compared to an eHCF alone or an AAF.
Asunto(s)
Caseínas , Fórmulas Infantiles/economía , Lacticaseibacillus rhamnosus/fisiología , Hipersensibilidad a la Leche , Probióticos/uso terapéutico , Caseínas/economía , Caseínas/uso terapéutico , Quelantes , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Lactante , Masculino , Hipersensibilidad a la Leche/diagnóstico , Hipersensibilidad a la Leche/economía , Hipersensibilidad a la Leche/epidemiología , Hipersensibilidad a la Leche/terapia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. PATIENTS AND METHODS: Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. RESULTS: The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 per child treated in the ITT analysis (CI95%: 12 ; 852 ) and 979 in the PP analysis (95%CI: 355 ; 1455 ) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 , PP -6358 ). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. CONCLUSIONS: For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.
Asunto(s)
Dermatitis Atópica/prevención & control , Fórmulas Infantiles/economía , Hidrolisados de Proteína/economía , Absentismo , Animales , Caseínas/economía , Caseínas/uso terapéutico , Niño , Preescolar , Dermatitis Atópica/dietoterapia , Dermatitis Atópica/economía , Método Doble Ciego , Femenino , Alemania/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Leche/efectos adversos , Proteínas de la Leche/economía , Proteínas de la Leche/uso terapéutico , Prevalencia , Hidrolisados de Proteína/uso terapéutico , Riesgo , Proteína de Suero de LecheRESUMEN
Metritis, endometritis and pyometra are common uterus inflammatory diseases, occurring mainly in the early postpartum period of livestock and farm animals. These infections are primarily associated with contamination of the reproductive tract, in particular uterine. Uterine infections bring to uterine and cervical involution as well as sub-fertility; the high economic loss, due to costs for treatment, milk withdrawal, reduced reproductive performance and premature culling, clearly demonstrate that uterine health in the postpartum period requires substantial medical veterinary attention. A wide variety of therapies for endometritis have been reported, including mainly antibiotics administered either by systemic or local somministration. Here, the patent application WO/2011/132191, which describes an alternative treatment for uterine infection, using casein peptides, is evaluated and discussed.
Asunto(s)
Antiinfecciosos/uso terapéutico , Enfermedades de los Bovinos/tratamiento farmacológico , Industria Lechera , Endometritis/veterinaria , Piómetra/veterinaria , Útero/efectos de los fármacos , Animales , Antiinfecciosos/efectos adversos , Antiinfecciosos/química , Antiinfecciosos/economía , Caseínas/efectos adversos , Caseínas/química , Caseínas/economía , Caseínas/uso terapéutico , Bovinos , Enfermedades de los Bovinos/economía , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/fisiopatología , Análisis Costo-Beneficio , Industria Lechera/economía , Costos de los Medicamentos , Farmacorresistencia Bacteriana , Endometritis/tratamiento farmacológico , Endometritis/economía , Endometritis/microbiología , Endometritis/fisiopatología , Femenino , Fertilidad/efectos de los fármacos , Legislación de Medicamentos , Patentes como Asunto , Periodo Posparto , Piómetra/tratamiento farmacológico , Piómetra/economía , Piómetra/microbiología , Piómetra/fisiopatología , Resultado del Tratamiento , Útero/microbiología , Útero/fisiopatologíaRESUMEN
OBJECTIVE: A pharmacoeconomic analysis was undertaken to determine costs, consequences, and cost-effectiveness of a brand of partially hydrolyzed 100%-whey formula manufactured by Nestlé (PHF-W), in the prevention of atopic dermatitis (AD) in 'at risk' Danish children compared to extensively hydrolyzed formula (EHF-Whey or Casein). METHODS: Given the non-significant differences between PHF-W and EHF, the base case analytic approach amounted to a cost-minimization analysis (CMA) reporting the difference in formula acquisition costs over the period of formula consumption for the population of interest. However, sensitivity analyses (SAs) were undertaken to explore applying the nominal efficacy of PHF-W and EHF, thus leading to a cost-effectiveness analysis (CEA). Hence, an economic model based on a 12-month time horizon was developed synthesizing treatment pathways, resource utilization, and costs associated with the treatment of AD in the population of interest. The final economic outcome of the SAs was the incremental cost per avoided case (ICER) defined as the expected cost per avoided case of AD for PHF-W vs EHF, determined from three perspectives: the Ministry of Health (MOH), the family of the subject, and society (SOC). RESULTS: In the base case CMA, savings of DKK 9 M, DKK 20 M, and DKK 29 M were generated for PHF-W vs EHF from the MOH, family, and SOC perspectives. In the sensitivity CEA, PHF-W was dominant over EHF-Whey from all perspectives, while EHF-Casein displayed against PHF-W unattractive ICERs of DKK 315,930, DKK 408,407, and DKK 724,337 from the MOH, family, and SOC perspectives. Probabilistic SAs indicated that PHF-W was 86% likely to be dominant over EHF-Whey, whereas EHF-Casein had no likelihood of dominating PHF-W. CONCLUSION: Under a range of assumptions, this analysis demonstrated the attractiveness of PHF-W vs both types of EHF in the prevention of AD among 'at risk' Danish infants who are not or cannot be exclusively breastfed.
Asunto(s)
Dermatitis Atópica/economía , Dermatitis Atópica/prevención & control , Fórmulas Infantiles/economía , Proteínas de la Leche , Modelos Económicos , Caseínas/economía , Preescolar , Análisis Costo-Beneficio , Dinamarca , Proteínas en la Dieta , Economía Farmacéutica , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Lactante , Fórmulas Infantiles/química , Hipersensibilidad a la Leche , Evaluación de Resultado en la Atención de Salud , Sensibilidad y Especificidad , Proteína de Suero de LecheRESUMEN
The literature data on milk protein (particularly kappa-casein) polymorphism study in different cattle breeds are represented. Allele variants of kappa-kasein are associated with lactation and have an influence on the composition of milk and its properties, including cheese-making properties. The importance of ways of kappa-casein genetic variants use in concrete selection programs are discussed.