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An Economic Analysis of a Peanut Oral Immunotherapy Study in Children
1Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Insights
Peanut oral immunotherapy (POIT) may be cost-effective, but can lead to more allergic reactions and anaphylaxis. This therapy
Area of Science:
- Allergy and Immunology
- Health Economics
- Pediatric Medicine
Background:
- Peanut oral immunotherapy (POIT) reduces accidental reactions but causes frequent therapy-related reactions.
- Economic evaluation of POIT is crucial for understanding its long-term value.
Purpose of the Study:
- To analyze the cost-effectiveness of POIT in children with peanut allergy.
- To model long-term outcomes and compare POIT with strict avoidance.
Main Methods:
- Cohort simulations were employed to assess POIT's impact on peanut allergy.
- The model incorporated age-adjusted mortality and food allergy risks.
- A POIT with probiotic regimen was used in the base-case scenario.
Main Results:
- The incremental cost-effectiveness ratio for POIT was $2142 per quality-adjusted life-year.
- POIT resulted in more allergic reactions (12.3 vs. 2.0) and anaphylaxis episodes (2.3 vs. 1.1) over 20 years compared to avoidance.
- POIT showed lower anaphylaxis rates than avoidance under specific conditions (e.g., >25% accidental reaction rate in avoidance group).
Conclusions:
- POIT demonstrates potential cost-effectiveness in long-term economic models.
- Patients on POIT may face increased rates of peanut-associated allergic reactions and anaphylaxis.
- The economic viability of POIT is sensitive to accidental reaction rates, adverse events, and induced tolerance likelihood.
Background:
Peanut oral immunotherapy (POIT) decreases the probability of accidental recurrent systemic reactions but reactions from the therapy itself are frequent.
Objective:
The purpose of this economic analysis was to characterize the potential cost-effectiveness of POIT.
Methods:
Cohort simulations were used to evaluate the effect of POIT for children with peanut allergy. A POIT with probiotic was used in the base-case simulation and long-term survival was modeled using age-adjusted mortality together with the risk of food allergy-associated mortality.
Results:
The incremental POIT cost-effectiveness ratio was $2142 per quality-adjusted life-year. A mean number of 12.3 (95% CI, 12.0-12.5) and 2.0 (95% CI, 1.9-2.1) allergic reactions occurred in the POIT and avoidance groups over 20 years of simulation, with 2.3 (95% CI, 2.2-2.3) episodes of anaphylaxis treated with intramuscular epinephrine per subject in the POIT group and 1.1 (95% CI, 1.0-1.2) episodes per subject in the avoidance group. In sensitivity analyses, POIT was associated with lower rates of anaphylaxis than strict avoidance when the annual rate of accidental allergic reactions in the peanut avoidance group exceeded 25%, the annual rate of anaphylaxis in the POIT group dropped below 6%, or the probability of sustained unresponsiveness after 4 years of POIT was 68% or greater.
Conclusions:
POIT may be cost-effective in a long-term economic model. However, treated patients may experience a greater rate of peanut-associated allergic reactions and anaphylaxis. The analysis was sensitive to rates of accidental allergic reactions, therapy-associated adverse events, and likelihood of therapy-induced tolerance.
