Modelling the resource implications and budget impact of new reimbursement guidelines for the management of cow milk allergy in Finland

ABSTRACT

Objective: To assess the impact of the decision by Kela (The Social Insurance Institution) to adopt guidelines for the management of food allergies in children, developed by the Finnish Medical Society Duodecim, as the basis for reimbursing clinical nutrition preparations for the treatment of cow milk allergy (CMA) in Finland.

Methods: A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the net resource implications and associated costs of Kela's new policy for the annual cohort of 1443 new CMA sufferers over the first 6 months following referral to a specialist. The analysis was conducted from the perspective of Kela, patients and Finnish society.

Results: Kela's new policy for reimbursing clinical nutrition preparations for the treatment of CMA is expected to increase healthcare resource use, including a 10% increase in the number of specialist visits over the first 6 months following referral. Consequently, Kela's 6-monthly expenditure on 1443 new CMA sufferers following referral is expected to increase by 12% from €889?389 to €992?761. Additionally, parents’ costs are expected to increase by 10% and fathers’ absenteeism from work to increase by 11% within the first 6 months following referral.

Conclusion: It is important to validate guidelines in clinical practice before their implementation. Within the limitations of our model, Kela's new criteria for reimbursing clinical nutrition preparations for the treatment of CMA is expected to increase healthcare resource use in paediatric departments in public hospitals in Finland and increase costs to Kela, patients and Finnish society.     

Identification of cow milk in goat milk by nonlinear chemical fingerprint technique

The objective of this paper was to develop a nonlinear chemical fingerprint technique for identifying and detecting adulteration of goat milk with cow milk. In this study, by taking the Belousov-Zhabotinsky oscillatory chemical reaction using acetone and substrates in goat milk or cow milk as main dissipative substances, when the same dosage of goat milk and cow milk was introduced to the “H⁺ + Mn²⁺ + BrO₃⁻ + acetone” oscillating system respectively, nonlinear chemical fingerprints were obtained for goat milk and cow milk from the same origin. The results showed that inductive time value and the content of cow milk in goat milk had a linear relationship in the range of 0–100% and the corresponding regression coefficient was 0.9991. A detection limit of 0.0107 g/g was obtained, and the content of cow milk in mixed milk was calculated. The proposed method in this study was simple, economical and effective. In addition, the method did not need the pretreatment and separation of samples for identifying and evaluating cow milk adulteration in goat milk.     

Cost-effectiveness of using an extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in the US

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.     

出生后呕吐为表现的牛奶蛋白过敏病儿 1例

目的探讨牛奶蛋白过敏病儿饮食治疗经验。方法回顾分析 2020年 3月中国科学技术大学附属第一医院收治的 1例以生后呕吐为表现的牛奶蛋白过敏病儿致生长发育迟缓的临床资料,对其治疗进行总结探讨。结果该例病儿生后即出现频繁奶后呕吐,入院后详细询问病史,并完善相关检查,诊断为牛奶蛋白过敏,予以更换氨基酸奶粉喂养后,病儿呕吐症状消失,体质量增长。结论限制饮食中牛奶蛋白的摄入是牛奶蛋白过敏病儿治疗的关键。     

婴幼儿牛奶蛋白过敏诊治进展

回顾婴儿牛奶蛋白过敏的发生机制,症状、辅助检查,诊断及治疗牛奶蛋白过敏的最新进展。牛奶蛋白过敏主要是由IgE和非IgE介导的免疫反应,其症状可表现为消化、呼吸、皮肤等一个或多个系统受损,牛奶回避-双盲激发试验为诊断的金标准,牛奶蛋白回避是治疗牛奶蛋白过敏的主要方法。     

食物过敏的诊疗研究进展

近几年,食源性过敏疾病的发病率逐年增加,已成为全人类越来越关注的食品公共卫生问题。它包括一系列由IgE介导的和/或非IgE介导的免疫系统疾病,如特应性皮炎、鼻结膜炎、哮喘、嗜酸性胃食管炎、食物蛋白诱导的小肠结肠炎、直肠结肠炎等。它与复杂的宿主因素和食品的种类、成分等密切相关,深人研究这些因素如何相互作用及食物变态反应性疾病的发生机制,从而对寻找有效的诊断和防治策略有重要的意义。     

Interlaboratory evaluation of a cow's milk allergy mouse model to assess the allergenicity of hydrolysed cow's milk based infant formulas

This study describes two phases of a multi-phase project aiming to validate a mouse model for cow's milk allergy to assess the potential allergenicity of hydrolysed cow's milk based infant formulas (claim support EC-directive 2006/141/E). The transferability and the discriminatory power of this model was evaluated in 4 research centers. Mice were sensitized by oral gavage with whey or extensively hydrolysed whey (eWH) using cholera toxin as an adjuvant. Whey-specific antibodies, mMCP-1 levels, anaphylactic shock symptoms, body temperature and the acute allergic skin response were determined upon whey challenge. In phases I and II, all 4 centers detected elevated levels of whey-specific IgE/IgG1 in whey sensitized animals. Elevated levels of mMCP-1, anaphylactic symptoms, body temperature drop and acute allergic skin response were scored upon whey challenge in 3 out of 4 research centers. In contrast, none of the evaluated parameters were elevated in eWH orally exposed groups. The cow's milk allergy mouse model is capable to distinguish the sensitizing capacity of complete or hydrolysed cow's milk protein. The model uses straightforward parameters relevant to food allergic responses and can be effectively transferred between different laboratories. We propose this mouse model as a new strategy for the screening of new hypoallergenic cow's milk formulas.     

Polyfluoroalkyl chemicals in the serum and milk of breastfeeding women

Polyfluoroalkyl chemicals (PFCs) comprise a group of man-made organic compounds, some of which are persistent contaminants with developmental toxicity shown in laboratory animals. There is a paucity of human perinatal exposure data. The US EPA conducted a pilot study (Methods Advancement for Milk Analysis) including 34 breastfeeding women in North Carolina. Milk and serum samples were collected at 2–7 weeks and 3–4 months postpartum; 9 PFCs were assessed in milk and 7 in serum. Perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) were found in nearly 100% of the serum samples. PFOS and PFOA were found at the highest concentrations. PFCs were below the limit of quantification in most milk samples. Serum concentrations of PFOS, PFOA and PFHxS were lower (p < 0.01) at the second visit compared to the first visit. Living in North Carolina 10 years or longer was related to elevated PFOS, PFOA and PFNA (p ≤ 0.03). These pilot data support the need to further explore perinatal PFC exposures and potentially related health effects, as planned in the upcoming National Children's Study which provided the framework for this investigation.     

Occurrence of aflatoxin M1 in raw cow,goat and sheep milk during spring and autumn in Croatia during 2016

Raw cow, goat and sheep milk samples were collected in different regions of Croatia during spring and autumn 2016. Aflatoxin M1 (AFM1) concentrations were measured in the following ranges (ng/kg): cow milk 0.93–85.4; goat milk 2.0–18.6; sheep milk 2.27–11.2. AFM1 levels exceeding the European Union maximum residue levels of 50?ng/kg were found in two cow milk samples in spring and 10 cow milk samples in autumn. The probable daily intakes (PDIs) for all three dairy species were from 0.0108 to 0.0165?ng/kg b.w./day and contributing 1.08–1.65% to the proposed provisional maximum tolerable daily intake (PMTDI; 1?ng/kg b.w./day), indicating low risk exposure for consumers. The mean positive cow milk PDI was 0.15?ng/kg b.w./day, contributing 15.2% to the PMTDI.     

Assessing the prevalence and characteristics of self-reported penicillin allergy in Saudi Arabian population: A nationwide cross-sectional study

IntroductionBeing allergic to penicillin can lead to the overuse of broad-spectrum antibiotics, contributing to the growing problem of multidrug resistance. Knowing the exact allergy history is essential as some circumstances may allow reinitiating penicillin. This study focused on assessing the prevalence and characteristics of self-reported penicillin allergy in the Saudi Arabian population.MethodsWe conducted a nationwide cross-sectional study via an electronic self-administered questionnaire directed toward the Saudi Arabian general adult population. Variables about respondent demographics as well as type and characteristics of the allergy were collected.ResultsOne hundred ninety-three out of 2022 participants who completed the survey (9.5%) reported allergy to penicillin, with the most reported reaction being anaphylaxis in 89 participants (46.1%), non-anaphylaxis reported by 69 participants (35.8%). Twenty-two participants (11.4%) were identified as not having a true allergy due to reporting a tolerability issue or a non-penicillin-type agent. About 38% reported that the allergy occurred more than ten years ago.ConclusionThis is the first study to report the prevalence and characteristics of self-reported penicillin allergy in Saudi Arabia. The data from this study provides valuable information to consider starting in-hospital penicillin de-labeling programs and providing evidence for healthcare providers to consider re-challenging certain qualified patients.     

Sensitizing capacity and allergenicity of enzymatically cross-linked sodium caseinate in comparison to sodium caseinate in a mouse model for cow's milk allergy

A transglutaminase cross-linked caseinate was designed for use in dairy products to increase the viscosity of food matrices. The difference in structure of cross-linked caseinate might have implications for the risk of developing cow's milk allergy. The sensitizing capacity and the allergenicity (the potency to induce an allergic effector response) of cross-linked sodium caseinate was investigated using a mouse model for cow's milk allergy.     

早产儿早期母乳和配方奶微量喂养的对比研究

目的探讨早期母乳微量喂养和配方奶微量喂养对早产儿胃肠功能、NEC的影响。方法将本科2011年6～12月收治的96例早产儿随机分为治疗组和对照组。治疗组为母乳微量喂养,对照组为配方奶微量喂养,观察并比较两组患儿喂养并发症的发生情况及1周后的生长发育情况。结果治疗组在喂养不耐受及NEC的发生率均低于对照组,且体重增长速度也较对照组有明显提高（P〈0．05）。呕吐、腹胀等喂养不耐受情况较对照组明显减少（P〈0．05）。结论早期给予母乳微量喂养可减少喂养并发症的发生,并能促进患儿生长发育。     

D-Proline: stereospecificity and sodium chloride dependence of lethal convulsant activity in the chick

Two- and five-day old chicks were injected intraventricularly with D-proline and structurally related compounds. D-proline produced convulsions and lethality, but was non-amnestic, whereas the naturally-occurring isomer, L-proline, was non-convulsant and non-toxic but amnestic. D-proline convulsions were accompanied by decreased high frequency in the EEG and increased slow wave activity. High amplitude spiking was not observed. The lethality of D-proline was saline-dependent. Control experiments ruled out possible toxic factors such as hypertonicity, pH pyrogens, injection volume, or needle misplacement. The results demonstrate that saline and distilled water are not equivalent injection vehicles. A sodium-free vehicle may lead to artifacts but is advantageous in experiments in which amino acid transport must be minimized.     

Development of two reference materials for all trans-retinol,retinyl palmitate, α- and γ-tocopherol in milk powder and infant formula

Vitamins are important food constituents that can be present in almost every foodstuff. Food quality and safety depends on food surveillance by reliable quantitative analysis enabled by appropriate quality control. Certified matrix reference materials are versatile tools to support quality assurance and control. However, in the case of vitamins, which are important in various foods, there is a lack of matrix reference materials. Two certified reference materials for the determination of all–trans-retinol, retinyl palmitate, and α- and γ-tocopherol in milk powder and infant formula have been developed by the National Institute of Standards, Egypt. This article presents the preparation, characterization, homogeneity, and stability testing as well as statistical treatment of data and certified value assignment. The assignment of the certified values and associated uncertainties in the prepared natural-matrix reference materials were based on the widely used approach of combining data from independent and reliable analytical methods.     

奶及奶制品摄入降低痛风患者血尿酸水平

随着我国人民生活水平的不断提高,饮食结构与生活习惯发生改变,痛风发病率明显增高且发病年龄提前。饮食治疗是预防痛风的一个重要手段,科学合理的饮食可以防治和减少痛风的发作。近年来有研究显示,奶及奶制品的摄入对痛风有预防作用。本文就此作一简述。     

Real or perceived impediments to minimum pricing of alcohol in Australia: Public opinion,the industry and the law

A burgeoning body of empirical evidence demonstrates that increases in the price of alcohol can reduce per capita alcohol consumption and harmful drinking. Taxes on alcohol can be raised to increase prices, but this strategy can be undermined if the industry absorbs the tax increase and cross-subsidises the price of one alcoholic beverage with other products. Such loss-leading strategies are not possible with minimum pricing. We argue that a minimum (or floor) price for alcohol should be used as a complement to alcohol taxation. Several jurisdictions have already introduced minimum pricing (e.g., Canada, Ukraine) and others are currently investigating pathways to introduce a floor price (e.g., Scotland). Tasked by the Australian government to examine the public interest case for a minimum price, Australia's peak preventative health agency recommended against setting one at the present time. The agency was concerned that there was insufficient Australian specific modelling evidence to make robust estimates of the net benefits. Nonetheless, its initial judgement was that it would be difficult for a minimum price to produce benefits for Australia at the national level. Whilst modelling evidence is certainly warranted to support the introduction of the policy, the development and uptake of policy is influenced by more than just empirical evidence. This article considers three potential impediments to minimum pricing: public opinion and misunderstandings or misgivings about the operation of a minimum price; the strength of alcohol industry objections and measures to undercut the minimum price through discounts and promotions; and legal obstacles including competition and trade law. The analysis of these factors is situated in an Australian context, but has salience internationally.     

Comparison of costs of sublingual immunotherapy and drug treatment in grass-pollen induced allergy: results from the SIMAP database study

ABSTRACT

Objectives: This analysis is focused on the comparison of costs of allergic rhinitis (R) alone or with allergic asthma (R?+?A) in grass pollen allergy, for subjects treated with sublingual immunotherapy (SLIT) and symptomatic drugs, versus standard care controls.

Methods: The SIMAP (Sublingual IMmunotherapy in Allergic Patients) study is a longitudinal observational database operated by a network of Allergy centers. Patients suffering from grass pollen allergy were included in this analysis and assigned to SLIT (plus drugs as needed) or to treatment with drugs alone. Outcome measures included use of medications, SLIT, visits and tests. Costs were assessed from the perspective of the Italian National Health Service; unit costs were obtained from published sources to produce an average cost/patient for the first year after enrolment.

Results: One hundred and two patients were analyzed. Demographics were comparable in the two groups. Overall per patient yearly cost of treatment was higher in SLIT patients, both in the whole sample (€311 vs. €180/patient), in the R (€288 vs. €116) and R?+?A (€362 vs. €230) subpopulations, with R?+?A patients generating more costs than R patients in both groups. Nevertheless considerable savings were obtained in the cost of symptomatic drugs (?22% for R; ?34% for R?+?A) in SLIT patients.

Conclusions: Other studies have shown that SLIT can reduce the use of drugs for asthma and rhinitis, but this is the first time this outcome has been demonstrated in a routine care population (in the medical practice environment of an observational study) within the first year of treatment.