Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

Laura Fanning; Ekaterina Woods; Catherine J Hornung; Kirsten P Perrett; Mimi L K Tang; Kim Dalziel

doi:10.1016/j.jval.2021.02.010

Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

Value Health. 2021 Sep;24(9):1360-1376. doi: 10.1016/j.jval.2021.02.010. Epub 2021 Apr 30.

Authors

Laura Fanning¹, Ekaterina Woods², Catherine J Hornung³, Kirsten P Perrett⁴, Mimi L K Tang⁴, Kim Dalziel⁵

Affiliations

¹ Health Economics Group, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Health Economics, Monash Business School, Monash University, Victoria, Australia.
² Health Economics Group, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁴ Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁵ Health Economics Group, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Electronic address: kim.dalziel@unimelb.edu.au.

PMID: 34452717
DOI: 10.1016/j.jval.2021.02.010

Abstract

Objectives: To identify published economic evaluations of interventions aimed at preventing, diagnosing, or treating food allergies in children.

Methods: We examined economic evaluations published from 2000 to 2019. Data analyzed included: food allergy type, study population/setting, intervention/comparator, and economic evaluation details. Quality assessment used reporting and economic modeling checklists. Two reviewers simultaneously undertook article screening, data extraction, and quality assessment.

Results: 17 studies were included: 8 peanut allergy (PA) studies, 8 cow's milk allergy (CMA) studies, and 1 egg allergy (EA) study. All PA studies reported incremental costs per quality-adjusted life-year gained for diagnostic strategies, management pathways for peanut exposure, and immunotherapies. Immunotherapies rendered inconsistent cost-effectiveness results. CMA studies reported costs per symptom-free day or probability of developing CMA tolerance. Cost-effectiveness of extensively hydrolyzed casein formula for CMA treatment was consistently demonstrated. Early introduction of cooked egg in first year of life dominated all EA prevention strategies. Quality assessment showed average noncompliance for 3.5 items/study (range 0-11) for modeling methods and 3.4 items/study (range 0-8) for reporting quality. Key quality concerns included limited justification for model choice, evidence base for model parameters, source of utility values, and representation of uncertainty.

Conclusion: Recent cost-effectiveness literature of interventions in PA, CMA, and EA is limited and diverse. Interventions for diagnosis and treatment of CMA and prevention of EA were generally cost-effective; however, results for PA were variable and dependent on effectiveness and utility values used. There is a need to expand economic evaluation of interventions for childhood food allergy and to improve methods and reporting.

Keywords: cost-effectiveness; cow’s milk allergy; egg allergy; food allergy; peanut allergy; pediatric.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Child
Cost-Benefit Analysis*
Delivery of Health Care / economics*
Food Hypersensitivity* / diagnosis
Food Hypersensitivity* / drug therapy
Food Hypersensitivity* / prevention & control
Humans