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Healthcare Use, Costs Greater in Children With Peanut Allergy, Study Says

Allison Inserro
Children allergic to peanuts have higher total healthcare costs and consume more healthcare services, including emergency department (ED) visits, and had comorbidities of allergic rhinitis, asthma, and atopic dermatitis, than those without the allergy. 
Children allergic to peanuts have higher total healthcare costs and consume more healthcare services, including emergency department (ED) visits, than those without the allergy, according to a poster presented at ISPOR 2019.

Over a 12-month period, one-third of patients with peanut allergy (PA) had anaphylactic reactions and more than 43% of ED visits among patients with the allergy were PA-related. In addition, costs were about twice as high for patients with PA, compared with those who did not.

Peanut exposure is a leading cause of food-induced allergic reactions and a cause for fatal food-induced anaphylaxis. Children with food allergies often have comorbidities of asthma and other atopic diseases, such as allergic rhinitis and eczema, and the presence of asthma is known to be a factor in worsening anaphylactic reactions.

Moreover, the severity of future reactions cannot be reliably predicted; the prevalence of severe food allergy is highest among children with PA—59.2% have a history of severe reactions. And despite the high prevalence and increased awareness of the risk of reactions, the current practice of strictly avoiding allergens and managing reactions when they occur is inadequate, the researchers said.

In this study, researchers examined medical claims from the MarketScan database to understand the burden of illness and healthcare resource utilization in children aged 4 to 11 with peanut allergy.

Patients in the database with at least 1 medical claim with a peanut allergy or related anaphylactic reaction diagnosis between January 1, 2010, to September 30, 2016, and continuous enrollment in medical/pharmacy benefits for 12 months before and after the index date were compared with children without PA or anaphylactic reactions.

Of the 109,596 patients with a claim for PA diagnosis or treatment, 41,744 individuals were included. Of those, 44.4% were aged 4 to 11 years; 13.1% were adults aged 19 to 64 years. Controls (1,222,108) were randomly selected and matched 1:1. Both groups had a mean age of 10.5 and 57.9% were male.

Of the patients with PA, 43.1% had allergic rhinitis, 35.6% had asthma, and 16% had atopic dermatitis.  

Total costs in patients with peanut allergy were $6436 vs $3717 for the control group (P <.01), driven by higher medical costs ($5002 vs $3055, P <.01). The mean costs associated with treating an anaphylactic reaction were $7976 for an inpatient hospitalization, $1214 for an ED visit and $2449 for ambulance transport.

During the follow-up period, 36% of patients had at least 1 anaphylactic reactions requiring medical attention and 32.8% of PA patients had at least 1 all-cause ED visit (vs 19.6% in controls, P <.01);

Of the ED visits, 43.5% were due to PA. In addition:
  • 79.1% of patients had ≥1 PA-related physician office visit
  • 68.1% of patients used  ≥1 other outpatient services during follow-up
Patterns were similar among patients aged 4 to 11: all-cause total costs were almost doubled among patients with PA compared to controls ($4818 vs $2711, P <.01. Among patients aged 4 to 11 with at least 1 ED visit, 39.2% were PA-related.

Patients with PA also had 2 times greater use of all-cause ambulance services (0.25 vs 0.12, P = .001) and more all-cause urgent care visits (0.23 vs 0.16, = .001)

The study was funded by DBV Technologies, which is planning to submit an application to the FDA in the third quarter of this year for its skin immunotherapy patch to treat peanut allergy. While the patch, called Viaskin, would not be a cure per se, it could protect some people with peanut allergy from small amounts of the legume that might otherwise lead to a severe reaction. About 1.6 million children in the United States have PA.

In an interview with The American Journal of Managed Care®, Todd Green, MD, the vice president of medical affairs at DBV and an associate professor of pediatrics at the University of Pittsburgh School of Medicine, said that in addition to the difference in healthcare costs and use, the study also highlights the suboptimal management of food allergy after a reaction.

Of note, only 58.5% of patients followed up with an allergist after the reaction, and only 65.2% received a prescription for an epinephrine autoinjector; Green said epinpehrine continues to be underprescribed. 

Even though there is more awareness about the prevalence of food allergy, “there’s still room to understand the more larger implications for healthcare resource utilization and incidence of anaphylaxis on a broad scale," he said. 

Taking everything together, "from a public health perspective, this is a group we should be concerned about," Green said. 

Reference

Chalil J, Vlahiotis A, Tran O, Shah H, Prinz M, Barrett C. Healthcare resource use (HCRU) and costs associated with peanut allergy (PA). Presented at: ISPOR 2019 Annual Meeting, New Orleans, Louisiana; May 18-22, 2019; Poster PRS19.

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