RESUMO
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.
Assuntos
Caseínas , Fórmulas Infantis/economia , Lacticaseibacillus rhamnosus/fisiologia , Hipersensibilidade a Leite , Probióticos/uso terapêutico , Caseínas/economia , Caseínas/uso terapêutico , Quelantes , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Humanos , Lactente , Masculino , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/economia , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/terapia , Estados Unidos/epidemiologiaRESUMO
⢠On the basis of strong research evidence, children with severe upper gastrointestinal tract bleeding should be treated with intravenous proton pump inhibitors. ⢠On the basis of some research evidence and consensus, children with severe gastrointestinal bleeding should be evaluated by endoscopy. ⢠On the basis of some research evidence and consensus, children in whom endoscopy has not been able to confirm a bleeding source should be considered for capsule endoscopy.