Is molecular allergology cost-effective and cost saving in children with suspected peanut allergy compared to double blind placebo controlled food challenge (DBPCFC), open oral food challenge and skin prick test in Sweden?

Background

Peanuts are one of the most common foods causing allergic reactions in children. IgE-ab sensitization to peanut has been reported in 7–11% of children in Western countries and the prevalence of peanut allergy (PA) in children varies between 0.75% and 3%. Given the PA impact on quality-of-life (QoL), accurate diagnosis is crucial because many sensitized individuals are actually tolerant to peanut. Peanut sensitization established by IgE antibodies (IgE-ab) in blood or skin prick test (SPT) often needs to be confirmed by the “gold standard” Double-blind placebo-controlled food challenge (DBPCFC), a risky and expensive procedure. In clinical practice an open oral food challenge (OC) is performed instead of a DBPCFC. PA can be effectively diagnosed using molecular allergology (MA), identifying subjects at risk for PA reactions (IgE-ab to Ara h 1-2-3). No cost-effectiveness (CE) analyses are available on MA for allergy.

Methods

Three 5-year Markov models simulate the flow of 200 children PA suspected presenting to the general practitioner. The models compare different diagnostic approaches (DBPCFC, OC, SPT and MA), computing the cost-per-QALY (Quality Adjusted Life Year) gained based on data from the literature. Calculations were performed for Sweden and BaseCase® was used to present results. Care giver indirect costs are included in a sensitivity analysis.

Results

In Sweden, cost-per-QALY is 3.66 for SPT, 3.22 for DBPCFC, 2.23 for OC and 4.34 for MA. The cost for different diagnostic approaches is:

• SPT: 44851 SEK

• DBPCFC: 24278 SEK

• OC: 33031SEK

• MA: 11267 SEK

Conclusion

In Sweden, MA increases QoL, and it is associated with reduced costs per patient with respect to the other strategies. The hypothesized usage of MA could be a valid alternative and a useful diagnostic tool replacing the “gold standard” DBPCFC in selected cases, DBPCFC still being useful in subjects with conflicting immunological/clinical results.

Disclosure of interest

S Glaumann: None declared, L-L Hermansson: Employee of Thermo Fisher Scientific, B Mascialino: Employee of Thermo Fisher Scientific, G Hubben: Employee of BaseCase Software, M Borres: Employee of Thermo Fisher Scientific, C Nilsson: None declared.