Public health and budget impact of probiotics on common respiratory tract infections: a modelling study

PLoS One. 2015 Apr 10;10(4):e0122765. doi: 10.1371/journal.pone.0122765. eCollection 2015.


Objectives: Two recent meta-analyses by the York Health Economics Consortium (YHEC) and Cochrane demonstrated probiotic efficacy in reducing the duration and number of common respiratory tract infections (CRTI) and associated antibiotic prescriptions. A health-economic analysis was undertaken to estimate the public health and budget consequences of a generalized probiotic consumption in France.

Methods: A virtual age- and gender-standardized population was generated using a Markov microsimulation model. CRTI risk factors incorporated into this model were age, active/passive smoking and living in a community setting. Incidence rates and resource utilization were based on the 2011-2012 flu season and retrieved from the French GPs Sentinelles network. Results of both meta-analyses were independently applied to the French population to estimate CRTI events, assuming a generalized probiotic use compared to no probiotics during winter months: -0.77 days/CRTI episode (YHEC scenario) or odds-ratio 0.58 for ≥1 CRTI episode (Cochrane scenario) with vs. without probiotics. Economic perspectives were National Health System (NHS), society, family. Outcomes included cost savings related to the reduced numbers of CRTI episodes, days of illness, number of antibiotic courses, sick leave days, medical and indirect costs.

Results: For France, generalized probiotic use would save 2.4 million CRTI-days, 291,000 antibiotic courses and 581,000 sick leave days, based on YHEC data. Applying the Cochrane data, reductions were 6.6 million CRTI days, 473,000 antibiotic courses and 1.5 million sick days. From the NHS perspective, probiotics' economic impact was about €14.6 million saved according to YHEC and €37.7 million according to Cochrane. Higher savings were observed in children, active smokers and people with more frequent human contacts.

Conclusions: Public health and budget impact of probiotics are substantial, whether they reduce CRTI episodes frequency or duration. Noteworthy, the 2011-12 winter CRTI incidence was low and this analysis focused on the fraction of CRTI patients consulting a practitioner.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Budgets*
  • Child
  • Child, Preschool
  • Humans
  • Markov Chains
  • Middle Aged
  • Models, Statistical
  • Probiotics*
  • Public Health*
  • Respiratory Tract Infections / epidemiology*
  • Risk Factors
  • Young Adult

Grants and funding

This study was funded by an unrestricted grant from the Global Alliance for Probiotics (GAP. URL: GAP had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ILW is employed by Danone, LG is employed by IMS RWES HEOR and GB was employed by IMS RWES HEOR during the course of the study. Danone and IMS RWES HEOR provided support in the form of salaries for authors ILW, LG and GB, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.