Cost-effectiveness of diagnostic algorithms for peanut allergy in children

Kunst, Natalia; Lindvik, Helene; Carlsen, Kai‐Håkon; Håland, Geir; Jørgensen, Eivind

doi:10.1016/j.jaci.2018.10.050

Cited by 2 publications

(10 citation statements)

References 9 publications

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“…1,28 A model-based cost-effectiveness analysis has been performed in a Norwegian cohort of children with suspected peanut allergy. 29 In support of our findings, the authors reported that a diagnostic flow chart based on peanut components (ie Ara h 1, 2, 3, 8 and 9) appeared to be more cost-effective than current clinical practice based on sIgE to peanut extract, skin prick testing and oral food challenges.…”

Section: Discussionsupporting

confidence: 85%

“…With an estimated 2400 referrals per year in the Netherlands this implicates a reduction in societal costs of € 767,101 per year when all children adhere to the diagnostic flow chart up to € 1,526,688 per year in daily practice 1,28 . A model‐based cost‐effectiveness analysis has been performed in a Norwegian cohort of children with suspected peanut allergy 29 . In support of our findings, the authors reported that a diagnostic flow chart based on peanut components (ie Ara h 1, 2, 3, 8 and 9) appeared to be more cost‐effective than current clinical practice based on sIgE to peanut extract, skin prick testing and oral food challenges.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children

Kansen

Erp

Meijer

et al. 2021

Clin Experimental Allergy

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Background Specific IgE to Ara h 2 is a diagnostic test for peanut allergy which may reduce the need for double‐blind placebo‐controlled food challenges (DBPCFC); however, guidance for using Ara h 2 in place of DBPCFCs has not been validated. Objective To prospectively evaluate 1) diagnostic accuracy of previously published Ara h 2 cut‐off levels to diagnose peanut allergy in children and 2) costs. Methods A consecutive series of 150 children age 3.5 to 18 years was evaluated in secondary and tertiary settings in the Netherlands. sIgE to Ara h 2 was the index test, and oral peanut ingestion was the reference test. Oral peanut ingestion was home or supervised introduction for Ara h 2 ≤ 0.1, DBPCFC for 0.1–5.0 and open food challenge for ≥5.0. Costs were calculated using financial healthcare data. Results A conclusive reference test was performed in 113 children (75%). Sixty‐four children (57%) had peanut allergy, as confirmed by a DBPCFC (27/47) or an open challenge (37/50). Forty‐nine children (43%) were considered peanut‐tolerant after peanut introduction (19/19), a DBPCFC (20/47) or an open challenge (10/50). Area under the curve for Ara h 2 was 0.94 (95% CI 0.90–0.98). The diagnostic flow chart correctly classified 26/26 (100%; 84–100) of children with Ara h 2 ≤ 0.1 as peanut‐tolerant and 34/35 (97%; 83–100) of children with Ara h 2 ≥ 5.0 as peanut‐allergic. At a cut‐off of ≤0.1 and ≥5.0, a sensitivity of respectively 100% (93–100) and 53% (38–67) was observed and a specificity of 53% (38–67) and 98% (87–100). Mean annual costs of the flow chart were estimated as €320‐€636 per patient lower than following national allergy guidelines. Conclusions In this diagnostic accuracy study, which did not take into account pretest probability, we have validated previously published Ara h 2 cut‐off levels which are associated with peanut tolerance and allergy.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of Ara h 2 for detecting peanut allergy in children

Kansen

Erp

Meijer

et al. 2021

Clin Experimental Allergy

View full text Add to dashboard Cite

show abstract

“…1), covering 3 types of food allergy and published between 2009 and 2019. Eight papers investigated PA, [24][25][26][27][28][29][30][31] 8 investigated CMA, [32][33][34][35][36][37][38][39] and 1 focused on EA. 40…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 describes study characteristics of the 17 studies. Economic evaluations in peanut allergy were conducted in the United States (n = 7), [24][25][26][28][29][30] Norway (n = 1), 27 and the United Kingdom (UK) (n = 1). 31 Seven economic evaluations were conducted from a societal perspective, [24][25][26][28][29][30] 1 from a public health payer perspective (Norway), 27 and 1 study did not mention the evaluation perspective.…”

Section: General Study Characteristics and Economic Evaluation Design...mentioning

confidence: 99%

“…Economic evaluations in peanut allergy were conducted in the United States (n = 7), [24][25][26][28][29][30] Norway (n = 1), 27 and the United Kingdom (UK) (n = 1). 31 Seven economic evaluations were conducted from a societal perspective, [24][25][26][28][29][30] 1 from a public health payer perspective (Norway), 27 and 1 study did not mention the evaluation perspective. 31 Diverse interventions were evaluated, which we broadly categorized into 3 groups: diagnostic strategies for peanut allergies, 27,28,31 management pathways for a child exposed to peanut or practices undertaken in children with a known peanut allergy, 24,29 and immunotherapies for peanut desensitization.…”

Section: General Study Characteristics and Economic Evaluation Design...mentioning

confidence: 99%

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