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

Janina Mertens, Stephanie Stock, Markus Lüngen, Andrea v. Berg, Ursula Krämer, Birgit Filipiak-Pittroff, Joachim Heinrich, Sibylle Koletzko, Armin Grübl, H. Erich Wichmann, Carl P. Bauer, Dietrich Reinhardt, Dietrich Berdel, Andreas Gerber

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


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 4months 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.

Original languageEnglish
Pages (from-to)597-604
Number of pages8
JournalPediatric Allergy and Immunology
Issue number6
StatePublished - Sep 2012


  • Atopic dermatitis
  • Atopic eczema
  • Cost-effectiveness analysis
  • Hydrolyzed formula
  • Nutrition
  • Prevention


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