Economic value of atopic dermatitis prevention via partially-hydrolyzed whey-based infant formula (PHF-W) use in high-risk, non-exclusively breastfed, Indonesian urban infants: results of a cost-effectiveness model

  • Marc F Botteman Bethesda, MD
  • Zakiudin Munasir Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia
  • Astrid W Sulistomo Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia
  • Erica G Horodniceanu Bethesda, MD
  • Abhijeet J Bhanegaonkar Bethesda, MD
  • Xiang Ji Bethesda, MD
  • Wing Yu Tang Bethesda, MD
  • Ray Wagiu Basrowi http://orcid.org/0000-0002-9507-527X
  • Patrick Detzel
Keywords: cost effectiveness, atopic dermatitis, infant formula, hydrolyzed formula, Indonesia

Abstract

Background:  Early nutritional intervention with partially-hydrolyzed whey-based formula (PHF-W) instead of standard cow’s milk formula (CMF) has been found to reduce the risk of atopic dermatitis (AD) development in non-exclusively breastfed infants with familial heredity of AD.Objective:  To estimate the 6-year economic impact of this nutritional intervention in non-exclusively breastfed Indonesian urban infants with family history of AD.Methods:  A mathematical model simulated AD incidence and burden of using PHF-W vs. CMF in the target population from birth to age 6. The model integrated literature, current cost and market catalogues, and expert clinician opinion. Modeled outcomes included AD risk, time spent post-AD diagnosis, days without flare, quality-adjusted life-years, and costs.Results: Using PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI: 4%, 23%) AD risk reduction, a 0.69 year (95% CI: 0.26, 1.13) per-child reduction in time spent post-AD diagnosis, a 38 (95% CI: 12, 67) increase in days without AD flare, and a 0.046 gain in quality-adjusted life-years. The AD-related 6-year cost estimates when feeding high-risk urban infants with PHF-W were Indonesian Rupiah (IDR) 8,695,057 (95% CI: IDR 4,519,447, IDR13,995,605) and IDR13,139,569 (95% CI: IDR 7,098,794, IDR 19,216,068) per child, respectively, resulting in a net per-child difference of IDR 4,444,512 (95% CI: IDR1,893,080, IDR 8,557,946) favoring PHF-W.Conclusion: PHF-W for the first 17 weeks of non-exclusively breastfed Indonesian urban infants with a hereditary risk of AD demonstrated a reduction in AD incidence, increased days without flare, and increased quality-adjusted life-years and net cost reductions.

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Author Biographies

Marc F Botteman, Bethesda, MD
Pharmerit International
Zakiudin Munasir, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia
Division of Allergy and Immunology, Department of Child Health
Astrid W Sulistomo, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia
Department of Community Medicine
Erica G Horodniceanu, Bethesda, MD
Pharmerit International
Abhijeet J Bhanegaonkar, Bethesda, MD
Pharmerit International
Xiang Ji, Bethesda, MD
Pharmerit International
Wing Yu Tang, Bethesda, MD
Pharmerit International
Ray Wagiu Basrowi
Nestlé Nutrition Institute
Patrick Detzel
Nestlé Research Center

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Submitted

2018-10-30
Accepted
2018-11-28
Published
2019-01-04
Section
Articles

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