Cost-Effectiveness Analysis of Undesignated Stock Epinephrine for Anaphylaxis in US Summer Camps

Anaphylaxis is life-threatening and requires immediate treatment with injectable epinephrine. Among the 20 million children attending US summer camps yearly, 2.5% (approximately 500 000) have immunoglobulin E (IgE)-mediated food allergies and fewer than half bring their epinephrine to camp.

We aimed to investigate the cost-effectiveness of stock epinephrine in US summer camps.

Using a decision-analytic Markov model, the outcomes of pediatric anaphylaxis were simulated using 4 strategies: (1) individual-provided epinephrine, (2) stock epinephrine, (3) current practice, and (4) stock epinephrine plus individual epinephrine. Secondary analyses included cost per hospitalization avoided and cost-effectiveness of nurse-drawn epinephrine solution and, in a 3-year model, intranasal epinephrine instead of autoinjectors.

Stock epinephrine was the least expensive and most effective ($4.33, 69.9 quality-adjusted life-days [QALDs]) strategy. The model was sensitive to the quantity of campers with IgE-mediated food allergy. In camps in which stock epinephrine was infeasible, individual-provided epinephrine was preferred. In 1-way sensitivity analyses, results were sensitive to epinephrine cost, IgE-mediated food allergy and anaphylaxis risks, hospitalization risk, and the number of weekly campers. Secondary analyses demonstrated that the individual-provided epinephrine strategy resulted in the most hospitalizations; stock epinephrine plus individual epinephrine cost $9476 per hospitalization avoided. Stock epinephrine plus individual epinephrine was the preferred strategy for nurse-drawn epinephrine solution ($8.72, 69.9 QALDs) and intranasal epinephrine ($27.07, 209.9 QALDs, 3 camp seasons).

A strategy of stock epinephrine autoinjectors alone was the most cost-effective in our model. A strategy of stock epinephrine plus individual epinephrine became more economically feasible when epinephrine costs were lower or IgE-mediated food allergy risk was higher.