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"To screen or not to screen": Comparing the health and economic benefits of early peanut introduction strategies in five countries.
- Source :
-
Allergy [Allergy] 2018 Aug; Vol. 73 (8), pp. 1707-1714. Date of Electronic Publication: 2018 May 24. - Publication Year :
- 2018
-
Abstract
- Background: Early peanut introduction (EPI) in the first year of life is associated with reduced risk of developing peanut allergy in children with either severe eczema and/or egg allergy. However, EPI recommendations differ among countries with formal guidelines.<br />Methods: Using simulation and Markov modeling over a 20-year horizon to attempt to explore optimal EPI strategies applied to the US population, we compared high-risk infant-specific IgE peanut screening (US/Canadian) with the Australiasian Society for Clinical Immunology and Allergy (Australia/New Zealand) (ASCIA) and the United Kingdom Department of Health (UKDOH)-published EPI approaches.<br />Results: Screening peanut skin testing of all children with early-onset eczema and/or egg allergy before in-office peanut introduction was dominated by a no screening approach, in terms of number of cases of peanut allergy prevented, quality-adjusted life years (QALY), and healthcare costs, although screening resulted in a slightly lower rate of allergic reactions to peanut per patient in high-risk children. Considering costs of peanut allergy in high-risk children, the per-patient cost of early introduction without screening over the model horizon was $6556.69 (95%CI, $6512.76-$6600.62), compared with a cost of $7576.32 (95%CI, $7531.38-$7621.26) for skin test screening prior to introduction. From a US societal perspective, screening prior to introduction cost $654 115 322 and resulted in 3208 additional peanut allergy diagnoses. Both screening and nonscreening approaches dominated deliberately delayed peanut introduction.<br />Conclusions: A no-screening approach for EPI has superior health and economic benefits in terms of number of peanut allergy cases prevented, QALY, and total healthcare costs compared to screening and in-office peanut introduction.<br /> (© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)
- Subjects :
- Age Factors
Australia
Canada
Child
Child, Preschool
Early Medical Intervention
Eczema
Egg Hypersensitivity
Health Planning Guidelines
Humans
Immunoglobulin E analysis
Infant
Markov Chains
New Zealand
Peanut Hypersensitivity immunology
Risk
United Kingdom
United States
Arachis immunology
Immunomodulation
Multiphasic Screening economics
Peanut Hypersensitivity economics
Peanut Hypersensitivity prevention & control
Skin Tests economics
Subjects
Details
- Language :
- English
- ISSN :
- 1398-9995
- Volume :
- 73
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Allergy
- Publication Type :
- Academic Journal
- Accession number :
- 29601091
- Full Text :
- https://doi.org/10.1111/all.13446