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A Health-Economic Analysis of Alpha-Gal Screening in the Asymptomatic Patient to Prevent Fatal Anaphylaxis
Marcus Shaker1, Julie Wang2, Derek Chu3
1Section of Allergy and Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
Background:
Sensitization to galactose-α-1,3-galactose (alpha-gal) can present with variable signs and symptoms. Although sensitization may be asymptomatic in a large proportion of individuals, in some it may present as alpha-gal syndrome (AGS) with risks for potentially fatal anaphylaxis if not managed appropriately.
Objective:
We conducted a health-economic evaluation of population screening to decrease the risk of fatal anaphylaxis from asymptomatic unrecognized alpha-gal sensitization.
Methods:
Markov models evaluated patients with asymptomatic sensitization comparing outcomes in patients identified to have sensitization through screening with those who did not undergo screening. Those with detected alpha-gal sIgE received prescriptions for self-administered epinephrine and were assumed to have a 10-fold decrease in the risk of anaphylaxis fatality. The model incorporated the associated disutility of food allergy diagnosis and allergic reactions, as well as costs of screening, emergency department evaluations, and hospitalizations. Probabilities and costs were derived from the medical literature. Population-level microsimulation evaluated 1% of the US population with outcomes considered over a 5-year treatment course.
Results:
In the population microsimulation (n = 3,431,477 per arm), costs were greater in the population receiving screening ($2,683,565,074 [standard deviation, SD, $2150] vs $1,711,493,170 [SD $1976]) with lower quality-adjusted life years (QALYs) in the screened population (15,355,262 QALYs [SD 0.35] vs 15,795,107 [SD 0.27]). A no-screening approach was associated with $972,071,904 in savings, while improving health quality by 439,845 QALYs. Extrapolated to the entire US population, not screening (compared with screening) would result in savings that could exceed $90 billion and preserve over 40 million QALYs during the 5-year horizon. Screening could be cost-effective if the annual anaphylaxis risk exceeded 50% for high-risk populations in whom identification of sensitization decreased the frequency of anaphylaxis.
Conclusion:
General screening of asymptomatic populations to prevent fatal AGS would be a low-value practice, though in patients at very high risk for severe anaphylaxis, screening could be considered.
