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The Cost-Effectiveness of Preschool Peanut Oral Immunotherapy in the Real-World Setting
Marcus Shaker1, Edmond S Chan2, Jennifer L P Protudjer3
1Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, and Dartmouth Geisel School of Medicine, Hanover, NH.
Insights
Preschool peanut oral immunotherapy (POIT) is a cost-effective strategy for managing peanut allergy (PA) in children. This treatment improves health outcomes and reduces healthcare costs in North America.
Area of Science:
- Allergy and Immunology
- Pediatric Health
- Health Economics
Background:
- Peanut allergy (PA) affects 1.4% to 4.5% of children in North America.
- Preschool peanut oral immunotherapy (POIT) is a proven safe and effective real-world treatment for pediatric PA.
Purpose of the Study:
- To evaluate the cost-effectiveness of preschool POIT in North America.
- To compare health and economic outcomes of POIT versus no immunotherapy for children with PA.
Main Methods:
- Markov cohort analyses and microsimulation models were used.
- Simulated preschool children with PA over an 80-year time horizon.
- Incorporated natural history of PA, costs in USD and CAD.
Main Results:
- Preschool POIT dominated non-immunotherapy approaches, improving quality-adjusted life-years (QALYs).
- POIT resulted in cost savings: US $82,514 (18.51 QALY) vs $84,367 (17.75 QALY); Canada $40,111 (18.83 QALY) vs $53,848 (18.26 QALY).
- POIT reduced systemic reactions, epinephrine use, and fatalities compared to no treatment.
Conclusions:
- Preschool POIT is a cost-effective strategy for pediatric peanut allergy.
- This immunotherapy improves both health and economic outcomes in the US and Canada.
Background:
Across North America, 1.4% to 4.5% of children and families live with peanut allergy (PA). Preschool peanut oral immunotherapy (POIT) has been shown to be safe and effective in the real-world setting.
Objective:
Evaluate the cost effectiveness of preschool POIT in North America.
Methods:
Markov cohort analyses and microsimulation was used to evaluate simulated preschool children with PA over an 80-year time horizon. Models incorporated the natural history of PA, comparing children treated with preschool POIT with those not receiving immunotherapy. Costs were expressed in U.S. and Canadian dollars.
Results:
A preschool POIT strategy was associated with cost savings while improving quality-adjusted life-years (QALY), dominating a nonimmunotherapy approach. Over the model horizon, when all costs (and effectiveness) of PA were included from a societal perspective, a POIT versus a non-POIT approach cost $82,514 (18.51 QALY) versus $84,367 (17.75 QALY) in the United States, and $40,111 (18.83 QALY) versus $53,848 (18.26 QALY) in Canada. In microsimulations, systemic reactions to POIT were less frequent than anaphylaxis from accidental exposure without POIT (United States: 3.59, SD 3.49 vs 19.53, SD 11.71; Canada: 3.63, SD 3.54 vs 4.56, SD 3.30), epinephrine use was reduced with POIT (United States: 5.85, SD 5.73 vs 9.76, SD 5.85; Canada: 0.34, SD 0.36 vs 0.53, SD 0.38), and fatalities were rare but lower in the POIT strategy (United States: 0.00005, SD 0.0071 vs 0.00015, SD 0.012; Canada: 0.00005, SD 0.0071 vs 0.00009, SD 0.0095).
Conclusions:
Preschool POIT in a real-world setting improved health and economic outcomes in the United States and Canada.
