Scientists say that general probiotic use in the United States could save the health care payer and the economy around $1.4 billion in medical bills and lost productivity due to acute respiratory tract infections (RTIs), which include influenza-like illnesses (ILIs) with symptoms ranging from mild cold to the more serious flu.

Although most acute RTI episodes of viral origin resolve on their own, RTIs result in a high number of doctor visits and pose a heavy burden on society and the health care system, according to the researchers who published their study (“Probiotics Reduce Health Care Cost and Societal Impact of Flu-Like Respiratory Tract Infections in the USA: An Economic Modeling Study”) in Frontiers in Pharmacology. The research was supported by an unrestricted grant from Chr. Hansen, a major producer of probiotic supplements

The systematic reviews by York Health Economics Consortium (YHEC) and Cochrane Collaborative reported that in randomized controlled trials probiotics use was associated with reduced number and duration of ILIs, antibiotic courses used, and days absent from work.

“The aim of this study was to assess the potential health-economic impact of probiotics on RTI-associated events and expenses in the US primary care setting. A state-transition microsimulation model reproduced a study population representative of the U.S. national demographics for age and gender (1/1,000 sample). RTI incidence was based on the influenza-like illness outpatient consultation rate reported by the Centers for Disease Control and Prevention (CDC) FluView. Data on vaccination, on factors that negatively impact RTI outcomes, on resource utilization, and on productivity loss were obtained from U.S. national databases. Analyses were performed for both meta-analyses independently,” the investigators wrote.

“Outcomes included cost savings for the health care payer, related to a reduced number of RTI episodes, less outpatient consultations, and decreased medical prescriptions as well as cost savings from a broader societal perspective related to productivity loss. The analysis showed that generalized probiotic intake in the U.S. population for 2017–2018 would have allowed cost savings for the health care payer of $4.6 million based on the YHEC scenario and $373 million for the Cochrane scenario, by averting 19 million and 54.5 million RTI sick days, respectively, compared to no probiotics. Antibiotic prescriptions decreased with 1.39–2.16 million courses, whereas absence from work decreased by 3.58–4.2 million days when applying the YHEC and Cochrane data, respectively.

When productivity loss is included, total savings for society represented $784 million and $1.4 billion for the YHEC and Cochrane scenarios, respectively. Subgroup analyses demonstrated an incremental benefit of probiotics in at-risk groups, which might be of relevance for targeted interventions. Sensitivity analyses confirmed the robustness of the model outcomes. Our analysis demonstrated a positive impact of probiotics on the health care and economic burden of flu-like RTIs. Improved disease outcomes translated into considerable cost savings for both the payer and society.”

“We wanted to assess how much the use of probiotics in the management of common acute RTIs could contribute to savings in healthcare costs in the U.S.,” said Daniel Tancredi, PhD, co-author on the study, an associate professor at the department of pediatrics and a researcher at the Center for Healthcare Policy and Research at University of California, Davis.

The authors developed an economic model to estimate the cost savings of general use of probiotics in the U.S. They created a simulation (1:1000 scale) reproducing a population representative of the national demographics. They tailored the model to account for age, vaccination status, smoking status, and time spent in shared indoor environments, such as daycare for children or shared offices for adult workers.

They estimated the number of ILI cases, the duration of illness, the costs associated with doctor visits, and the number of days missed from school or work. For these estimates, they used the 2017–18 influenza season of FluView from the CDC and other national databases.

The researchers modeled the illness experience for the simulated population under two scenarios: one where everyone uses probiotics and one where no one does. They did a simulated model based on the Cochrane Collaborative review and another based on the YHEC review. The Cochrane review accounted for reductions both in number of episodes of RTIs and disease duration, allowing for the estimation of the cost savings associated with fewer doctor visits. The YHEC review could only quantify savings associated with fewer sick days due to RTI.

“Although flu-like illnesses usually resolve on their own after one or two weeks, there is great benefit in reducing ILI incidence and duration,” said Irene Lenoir-Wijnkoop, first author on the study and senior scientist in public health nutrition at Utrecht University in the Netherlands. “Less sickness means reduced suffering and significant cost savings from health care expenses and sick absences.”

In the Cochrane scenario, the analysis showed that if everyone in the U.S. took probiotics, health care payers would save $373 million in RTI-associated medical bills in one year. These savings include the cost of more than two million courses of antibiotic prescriptions averted and correspond to a decrease of 54.5 million sick days. When counting the savings from reduced productivity loss of 4.2 million workdays, the total savings for society would amount to $1.4 billion.

In the YHEC scenario, generalized probiotic use could save $784 million per year for averted productivity loss related to absence from work due to illness.

“Because both reviews included studies from different strains of probiotics, including both effective and ineffective ones, our results are based on an estimated average effect,” explained Tancredi. “With more evidence on which probiotics are effective in protecting against RTIs, it would be possible generate more definitive estimates of the potential cost savings associated with their use.”

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