Providing cost-effective care for food allergy

Area of Science:

• Allergy and Immunology
• Health Economics
• Public Health

Background:

• Food allergy management encompasses various strategies, including screening, diagnosis, and treatment.
• Evaluating the economic impact of these strategies is crucial for resource allocation and optimal patient care.
• Previous cost-effectiveness analyses in this field have yielded varied results, necessitating a comprehensive review.

Purpose of the Study:

• To systematically review and synthesize the existing literature on the cost-effectiveness of different food allergy management strategies.
• To identify which management approaches are economically viable and which require optimization.
• To inform clinical guidelines and healthcare policy regarding food allergy care.

Main Methods:

• A narrative review and synthesis of relevant literature.
• Systematic search of PubMed for articles evaluating the cost-effectiveness of food allergy management.
• Inclusion of studies reporting on screening, diagnosis, allergen labeling, emergency care, and immunotherapy.

Main Results:

• Infant peanut allergy screening is not cost-effective due to overdiagnosis risks.
• Optimizing care involves timely oral food challenges, clarifying allergen labeling, patient-preference sensitive emergency service activation, and value-based pricing for epinephrine.
• Peanut immunotherapy (epicutaneous or probiotic-based) shows favorable cost-effectiveness, particularly with improved health utility and sustained unresponsiveness.

Conclusions:

• Several aspects of current food allergy management lack cost-effectiveness.
• Incorporating patient and family preferences into decision-making is essential for guideline-based care.
• Further research is needed to understand health state utilities in specific patient populations for improved cost-effectiveness analyses.