Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany


Andreas Gerber, MD, PhD, IQWiG, Im Mediapark 8, 50670 Koeln, Cologne, Germany
Tel.: 49 221 35686 301
Fax: 49 221 35685 1


To cite this article: Mertens J, Stock S, Lüngen M, Berg AV, Krämer U, Filipiak-Pittroff B, Heinrich J, Koletzko S, Grübl A, Wichmann H-E, Bauer C-P, Reinhardt D, Berdel D, Gerber A. Is Prevention of Atopic Eczema with Hydrolyzed Formulas Cost-Effective? A Health Economic Evaluation from Germany. Pediatr Allergy Immunol 2012: 23: 597–604.


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.