Health economics perspective in allergy prevention in children
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Health economics perspective in allergy prevention in children

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Keywords: allergic disease. prevalence, economic burden, prevention

Keywords: allergic disease. prevalence, economic burden, prevention

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Health economics perspective in allergy prevention in children Health economics perspective in allergy prevention in children Presentation Transcript

  • Health Economics Perspective in Allergy Prevention in Children Prof Ariyanto Harsono MD PhD SpA(K) Department of Child Health Airlangga University /Dr Soetomo Hospital Surabaya, Indonesia
  • Background  Prevalence of allergic disease is increasing.  Allergies are the most frequent chronic diseases in children and young adults.  The impact of allergies: o Individual sufferers Impairment in quality of life, sleep and mood, competence at work or school and overall personal development. Costs o Society as a whole. Costs A European Declaration on Immunotherapy
  • GENETIC FACTOR •ALLERGEN •INFECTION • POLUTANT ENVIRONMENT FACTOR ALLERGIC DISEASES Gern JE, Lemanske Jr RF. Immunol Allergy North Amer 1999; 19:233-52 3Prof DR Dr Ariyanto Harsono SpA(K)
  • Allergic diseases A European Declaration on Immunotherapy
  • 5Prof DR Dr Ariyanto Harsono SpA(K)
  • Prevalence of asthma Prevalence of asthma symptoms by country among children 13 to 14 years of age according to the 1999- 2004 International Study of Asthma and Allergies in Childhood (ISAAC) Prevalence of asthma symptoms by country among children 6 to 7 years of age according to the 1999-2004 International Study of Asthma and Allergies in Childhood (ISAAC) III study. Asher MI, et al. Lancet. 2006;368:733-43.
  • The Rising Incidence of Atopic Dermatitis • Atopic dermatitis is now one of the most common childhood disorders in the Asia Pacific region • Its prevalence has increased markedly in the past decade Adapted from Asher et al, 2006 Change in incidence of atopic dermatitis
  • Prevalence of allergy 6.9% 9.0% 4.9% 8.9% 14.2% 3.9% 13.9% 12.3% 24.6% 0% 5% 10% 15% 20% 25% Jakarta Pusat (1990) ISAAC Jakarta Timur (2001) EAAEL Jakarta (2006) Asma Rinitis alergi Dermatitis atopi Courtesy of Dr. dr. Zakiudin Munasir, SpA(K)
  • Economic impact of allergic diseases • Hospital (in/outpatient) • Physician services • Medication • Diagnostic tests Direct costs, medical • Transportation • Homecare devices • Special diet Direct costs, non-medical • Loss of work and school days • Loss potential earning • Home modification • Mortality Indirect costs
  • Direct costs to society of allergy in Europe (1998 euros) • Asthma 6.4bn • Contact dermatitis 2.3bn • Allergic rhinitis 1.3bn • Food allergy [???] Source: European allergy white paper (1997)
  • Estimated costs of allergic diseases in Europe A European Declaration on Immunotherapy
  • HOW CAN WE PREVENT ALLERGIC DISEASES?
  • Prof DR Dr Ariyanto Harsono SpA(K) 13
  • Prevention of allergic diseases Preventionofallergicdisease Primary Secondary Tertiary
  • Primary prevention Recognize the high risk infants
  • Nutrition factor in allergy prevention Nutrition Recommendation Breastfeeding Infants should be exclusively breast-fed in the first four months to prevent atopic diseases Maternal nutrition during pregnancy and/or breastfeeding Balanced and fully nutritious diet is recommended during pregnancy and breastfeeding. There is no well-documented evidence favoring a recommendation for any type of dietary restriction during pregnancy or breastfeeding (avoidance of potent dietary allergens) Feeding of children at risk with mother’s milk substitutes Infants at high risk of allergic disease should be given hydrolyzed formula (partially or extensively hydrolyzed formula). Soy-based infant formula is not recommended for the purpose of allergy prevention. Introduction of solid food in the first year Introducing complementary solid foods from around 4–6 months, with no specific avoidance of allergenic foods. Muche-Borowski C. Allergy prevention. Dtsch Arztebl Int. 2009; 106: 625–31. Prescott S, Nowak-Wegrzyn A. Ann Nutr Metab 2011;59:28–42.
  • Hydrolyzed Formula • Systematic review (2005): – Extensively hydrolyzed casein formulas and partially hydrolyzed whey formulas are appropriate alternatives to breast milk for allergy prevention in infants at risk. – The use of these formulas in the general population should be considered, and one must weigh cost, compliance, and long-term benefits. Arch Pediatr Adolesc Med. 2005;159:810-6
  • Hydrolyzed formula (German Infant Nutrition Study) Adjusted cumulative incidence of parent-reported physician-diagnosed eczema Von Berg A, et al. J Allergy Clin Immunol. 2013 Jun;131(6):1565-73
  • ECONOMIC IMPACT OF HYDROLYZED FORMULA AS ALLERGIC PREVENTION
  • Three perspectives of economic evaluation The public healthcare system (Ministry of Health) Family Society Iskedjian M, et al. J Med Econ.2012; 15: 394-408 Iskedjian M, et al. J Med Econ.2012; 15: 378-93
  • PARTIALLY HYDROLYZED FORMULA VS STANDARD FORMULA
  • Costs associated with PHF-W and standard formula for allergy prevention: Perspective of the Switzerland’s MOH Cost of formula Physician costs Treatment costs Hospitaliza tion costs Costs of lab test PHF-W 14398641 173830 109013 46457 10844 SF 12519931 299444 196925 80029 18681 0 2000000 4000000 6000000 8000000 10000000 12000000 14000000 16000000 CHF Item Expected numbers of cases: PHF-W: 2287; SF: 39040; Avoided cases: 1653 Iskedjian M, et al. J Med Econ.2012; 15: 394-408
  • Costs associated with PHF-W and standard formula for allergy prevention: Perspective of the Switzerland’s family Cost of formula Physicia n costs Treatm ent costs Hospita lization costs Costs of lab test Cost of time lost Travel cost PHF-W 1602980 19314 12113 5162 1205 5019849 221129 SF 1402632 33272 21881 8892 2076 8672290 380506 0 1000000 2000000 3000000 4000000 5000000 6000000 7000000 8000000 9000000 10000000 CHF Item Expected numbers of cases: PHF-W: 2287; SF: 39040; Avoided cases: 1653 Iskedjian M, et al. J Med Econ.2012; 15: 394-408
  • Cost-effectiveness 6881752 10521547 -3639795 -1220 -6000000 -4000000 -2000000 0 2000000 4000000 6000000 8000000 10000000 12000000 CHF Total cost PHF-W Total cost SF Incremental costs Incremental cost-effectiveness ratio • PHF-W vs SF Iskedjian M, et al. J Med Econ.2012; 15: 394-408
  • PARTIALLY HYDROLYZED FORMULA VS EXTENSIVELY HYDROLYZED FORMULA
  • Costs associated with PHF-W, EHF-W, EHF-C for allergy prevention: Perspective of the Danish family Expected numbers of cases: PHF-W: 453; EHF-W: 728; EHF-C: 428; Avoided cases: 274 (EHF-W); 26 (EHF-C) Cost of formula Treatment costs Cost of time lost Travel cost EHF-C 26594813 292829 4359488 271090 EHF-W 26658963 498312 7412350 461447 PHF-W 7157386 310399 4621057 287355 0 10000000 20000000 30000000 40000000 50000000 60000000 70000000 DKK Iskedjian M, et al. J Med Econ.2012; 15: 378-93
  • Cost effectiveness PHF-W vs EHF-W 12376196 35031072 -22654875 -82565 -40000000 -20000000 0 20000000 40000000 Total cost PHF-W Total cost EHF-W Incremental costs Incremental cost-effectiveness ratio PHF-W vs EHF-C 12376196 31518220 -19142024 -746073 -30000000 -20000000 -10000000 0 10000000 20000000 30000000 40000000 Total cost PHF-W Total cost EHF-C Incremental costs Incremental cost-effectiveness ratio Iskedjian M, et al. J Med Econ.2012; 15: 378-93
  • pHF-W is not only clinically effective, it is also cost effective – European Based on the European studies, families with children at risk of atopic dermatitis will save between EUR 624 and EUR 2,200 per year compared with using standard formula Adapted from Spleindenner, 2011 Number of cases of atopic dermatitis avoided and cost saving from the perspective of the family
  • pHF-W is not only clinically effective, it is also cost effective – Thailand and Australia • Thailand Every single child with atopic dermatitis represent a direct cost of THB 5,432 (US $ 175) • Australia
  • Decision making: 1. “ benefit > risk” 2. low “cost” 3. “applicable” Choices of nutrition for allergy prevention 1. Breastfed 2. Soy Protein Formula 3. p-Hydrolyzed Whey 4. p-Hydrolyzed Casein 5. e-Hydrolyzed Whey 6. e-Hydrolyzed Casein APPLICABILITY + + + + + + LOW COST + + + + - - LOW RISK + - + + + + BENEFIT + - + - - +
  • Infant Child Sensitization Clinical Manifestation History of Atopic family •Breast Milk •pHF •Probiotik Primary Prevention Secondary Prevention Tertiary Prevention •Elimination Diet •Substitution Formula (AAF/eHF/Soy) •Steroid, antihistamine •Emergency Treatment •Promising Treatment •Immunotherapy Prevention Strategy SPT IgE RAST 31Prof DR Dr Ariyanto Harsono SpA(K) Atopic Dermatitis Asthma, Allergic Rhinitis Gastrointestinal Allegy •eHF •Soy F
  • Conclusions • Prevalence of allergic diseases are increasing • Burden of the diseases includes symptom burden, impaired quality of life and productivity, co-morbidities, complications, and disease management (economic burden) • Prevention of allergic diseases should be started in early life. • If breastfeeding is not possible, a partially hydrolyzed formula is cost-effective for infants at high risk of allergic disease.
  • THANK YOU