An Economic Evaluation of Immediate Verses Non-immediate Activation of Emergency Medical Services After Epinephrine Use for Peanut-induced Anaphlaxis

Publication date: Available online 17 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Marcus Shaker, Tsuzumi Kanaoka, Lynn Feenan, Matthew Greenhawt

Abstract

Background

Layperson food allergy management plans commonly stipulate that if epinephrine is used to "immediately call 911 and seek care in the nearest medical facility" for observation. Objective: To evaluate the cost-effectiveness of this strategy, versus a watchful waiting approach before activating emergency medical services (EMS).

Methods

We performed a cost-effectiveness analysis using Markov modeling simulated over a 20-year horizon comparing activating EMS immediately after epinephrine use for allergic reactions to peanut vs. a "wait and see" approach in which EMS was only activated if symptoms of the reaction did not promptly resolve after treatment. The base-case model assumed a 10-fold increased fatality risk with delayed EMS activation.

Results

The fatality risk associated with early EMS use was minimal, with a per-patient fatality rate over a 20-year horizon of 1.2 × 10-6, vs. 1.9 × 10-6 for a "wait and see" approach. The incremental cost per life-year saved was $142,943,447 for early EMS vs "wait and see," with the cost per death prevented reaching $1,349,335,651 as the simulation concluded. Cost of early EMS activation rose to $321,625,534 per lifeyear saved ($3,035,454,848 per death prevented) if a 5-fold increase in fatality risk was assumed, and was $12,997,173 per life-year saved ($122,689,936 per death prevented) if a 100-fold increase in fatality risk was assumed.

Conclusion

Medical observation of a treated and promptly resolved peanut allergic reaction has minimal benefit and excessive costs. Immediately activating EMS after using epinephrine for a peanut allergic reaction in this context is not cost-effective.

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