Egg oral immunotherapy is more cost-effective in older children
Published online December 13, 2024
Egg oral immunotherapy can desensitize children with egg allergy so that they are at lower risk of allergic reaction when eating egg. However, it is a lengthy treatment involving regular supervised visits while doses of egg are increased for a year or more. It is therefore time consuming and costly for both families and clinical services. Young children are also very likely to outgrow their egg allergy naturally over time, with over 90% of egg allergies resolving by age 10. It is unclear whether the more cost-effective strategy is to implement treatment early or wait until the child is older and the chance of outgrowing their allergy decreases.
To address this question, Lloyd and colleagues conducted an economic evaluation, published in a recent issue of The Journal of Allergy and Clinical Immunology: In Practice. The authors investigated whether egg oral immunotherapy is a cost-effective treatment and whether cost-effectiveness changes when treatment is started at different ages. The evaluation was conducted from the perspective of the Australian health system using a treatment protocol previously shown to effectively desensitize a high proportion of treated children in a randomized clinical trial. Key drivers of cost-effectiveness were explored to determine which modifiable factors can be targeted to reduce the clinical and cost burden of this treatment.
A key assumption of the model was that the clinical management of a child who is desensitized to egg is more intensive than for a child whose allergy is in remission. When remission is achieved, the allergy is considered resolved, similar to the development of natural tolerance, allowing free consumption of egg and removing the need for frequent visits to a physician and ultimately the need to carry an adrenaline injector. These benefits are not realized in children who are desensitized without remission; they continue to require regular egg dosing under the careful supervision of an allergy clinician, and while risk is reduced, they may still experience allergic reactions.
Modelling showed that egg oral immunotherapy is more cost-effective if treatment is delayed until ages 8-12. This is primarily due to the high proportion of younger children who outgrow their egg allergy naturally without treatment, negating the benefit gained from the intensive treatment regime that requires significant investments of time, effort, and cost by families and health systems. Cost-effectiveness is greatly improved if a proportion of treated children achieve remission of their egg allergy, and if the proportion attaining remission is 40% or higher, the treatment may be cost-effective in children as young as four. Cost-effectiveness is reduced for children with multiple food allergies, assuming these will persist even if the egg allergy is treated. Less clinically intensive approaches to oral immunotherapy are required to improve cost-effectiveness in younger children, and multi-food options are required for children with multiple food allergies.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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