Plain language summary
Acute respiratory tract infections (RTI) are common and range from mild cold symptoms to influenza. Although most RTIs resolve spontaneously they result in a high number of outpatient consultations and pose a heavy burden on society and health care systems. Studies have shown that probiotics can help prevent RTIs, shorten RTI duration and reduce antibiotic use. The aim of this study was to quantify the effect of probiotics on RTI-related health and related cost and productivity loss in the US primary care setting. The authors did this by using a simulation model, which enabled them to track the disease pathway of each subject, accumulating costs and events. The authors found that while the benefits of probiotic consumption in terms of RTIs are small at an individual level, when applied to the US population as a whole, the health impact is sizable, and could potentially save approximately 1.4 billion USD with probiotic supplementation. Benefits were larger for at-risk populations, including children and individuals with a shared indoor environment (e.g. school, office). The authors conclude that recommending daily probiotic consumption may be justified for particular at-risk populations.
Acute respiratory tract infections (RTIs) of viral origin place a substantial burden on health care resources and society. Randomized controlled trials have shown positive effects of probiotics on clinical outcomes in these commonly occurring RTIs. Two meta-analyses published by the York Health Economics Consortium (YHEC) and Cochrane reported the efficacy of probiotics in reducing incidence and duration of RTIs, number of antibiotic courses, 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 US 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 US national databases. Analyses were performed for both meta-analyses independently. 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 US population for 2017-2018 would have allowed cost savings for the health care payer of 4.6 million USD based on the YHEC scenario and 373 million USD 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 or 1.4 billion USD 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.