Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Food Challenge and Research Unit, Aurora, Colorado.
Ann Allergy Asthma Immunol. 2019 Sep;123(3):240-248.e1. doi: 10.1016/j.anai.2019.05.015. Epub 2019 May 23.
To review the cost-effectiveness of food allergy management strategies.
A narrative review and synthesis of literature identified using a PubMed search of relevant articles describing cost-effectiveness evaluations of food allergy management.
Screening at-risk infants for peanut allergy carries risk of overdiagnosis and is not cost-effective. Evidence suggests that cost-effective care could be better optimized by minimizing delay in oral food challenges for eligible patients, clarifying the role of precautionary allergen labeling, incorporating patient-preference sensitive care in activation of emergency medical services for resolved allergic reactions, and considering value-based pricing and school-supply models for epinephrine. Finally, the annual value-based cost (willingness to pay [WTP] $100,000/quality-adjusted life years [QALY]) of peanut immunotherapy has been estimated to be between $1568 and $6568 for epicutaneous immunotherapy (EPIT) and between $1235 and $5235 for probiotic with peanut oil immunotherapy (POIT), with each therapy showing more favorable cost-effectiveness with greater improvements in health utility, particularly if sustained unresponsiveness can be achieved.
Many aspects of food allergy management are not cost-effective, and recent evaluations suggest a greater role for incorporating patient and family preferences into guideline-based and traditionally reflexive management decisions. Caregiver understanding of food allergy screening tradeoffs is critical, given that screening children before allergen exposure has significant costs and results in overdiagnosis, especially when oral food challenges are omitted from diagnostic algorithms. Cost-effectiveness analysis can help to identify important decision levers in patient management across a wide range of topics. Further research is needed to better understand health state utilities of specific patient populations.
评价食物过敏管理策略的成本效益。
通过对描述食物过敏管理成本效益评估的相关文章进行 PubMed 检索，进行了叙述性综述和文献综合。
对花生过敏高危婴儿进行筛查存在过度诊断的风险，且不具有成本效益。有证据表明，通过尽量减少符合条件的患者口服食物挑战的延迟、明确预防性过敏原标签的作用、在解决过敏反应时激活紧急医疗服务时纳入患者偏好敏感护理，并考虑基于价值的定价和学校供应模型用于肾上腺素，可以更好地优化具有成本效益的护理。最后，花生免疫疗法的年度基于价值的成本（愿意支付[WTP]100000 美元/QALY）估计为经皮免疫疗法（EPIT）的 1568 美元至 6568 美元之间，以及含花生油益生菌免疫疗法（POIT）的 1235 美元至 5235 美元之间，每种疗法在健康效用方面的改善越大，成本效益越高，特别是如果能实现持续无反应。
食物过敏管理的许多方面都不具有成本效益，最近的评估表明，在基于指南和传统反射性管理决策中纳入患者和家庭偏好的作用更大。鉴于在过敏原暴露前对儿童进行筛查会带来重大成本，并导致过度诊断，尤其是在诊断算法中省略口服食物挑战时，了解食物过敏筛查权衡利弊对照顾者来说至关重要。成本效益分析有助于确定患者管理中广泛主题的重要决策杠杆。需要进一步研究以更好地了解特定患者群体的健康状态效用。
