An economic evaluation of immediate vs non-immediate activation of emergency medical services after epinephrine use for peanut-induced anaphylaxis

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
Marcus ShakerMatthew Greenhawt

Abstract

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. To evaluate the cost-effectiveness of this strategy, vs a watchful waiting approach before activating emergency medical services (EMS). 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. 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 life-year saved ($3,035,454,848 per death prevented) if a 5-fold increase in fatality risk was assumed, and was $12,997,...Continue Reading

Citations

Apr 3, 2019·Current Opinion in Pediatrics·Dana ToyMarcus Shaker
Oct 24, 2019·JAMA Network Open·Marcus ShakerMatthew Greenhawt
May 16, 2019·Current Opinion in Pediatrics·Dana ToyMarcus Shaker
Apr 8, 2020·The Journal of Allergy and Clinical Immunology. in Practice·Priya BansalMarcus Shaker
Apr 22, 2020·The Journal of Allergy and Clinical Immunology. in Practice·Thomas B CasaleAnna Nowak-Wegrzyn
Dec 1, 2020·The Journal of Allergy and Clinical Immunology. in Practice·Elissa M AbramsMatthew Greenhawt
Jan 25, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Marcus ShakerMatthew Greenhawt
Jan 23, 2021·Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology·Philippe A EigenmannRobert A Wood
Feb 4, 2021·Current Opinion in Allergy and Clinical Immunology·S Shahzad MustafaMatthew Greenhawt
Jul 18, 2020·The Journal of Allergy and Clinical Immunology. in Practice·Elissa M AbramsMatthew Greenhawt
Jul 30, 2020·The Journal of Allergy and Clinical Immunology. in Practice·Douglas P MackMatthew Greenhawt
May 10, 2021·The Journal of Allergy and Clinical Immunology·Susan WasermanJan L Brozek
Jun 12, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Marcus Shaker, Matthew Greenhawt
Jun 21, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Elissa M AbramsMarcus Shaker
Aug 29, 2021·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Laura FanningKim Dalziel
Jan 1, 2022·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Alyssa G Burrows, Anne K Ellis
Jun 16, 2019·The Journal of Allergy and Clinical Immunology. in Practice·Marcus Shaker, Matthew Greenhawt

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