Methods: Decision analysis software (TreeAge Pro, Williamstown MA) was used to evaluate costs of living with food allergy. A comparative prescription drug pricing service (www.goodrx.com; accessed 8/27/16) was used to incorporate costs of EPN or EIA into Markov microsimulations for children with peanut allergy over a twenty-year time horizon. Annual event probabilities were modeled and costs also included provider visits, ambulance transports, emergency care, hospitalizations, grocery costs, and job-related opportunity costs.
Results: The lowest EPN and EIA double pack costs were $616.00 and $144.62, respectively. Assuming annual prescriptions for two double packs (home and school), the mean costs of living with peanut allergy totaled $58,667 (95% CI $57,745 - $59,588) if EPN was prescribed and $45,588 (95% CI $44,873 - $46,304) with EIA. No effectiveness differences were evident between groups with 17.19 (95% CI 17.11-17.27) quality-adjusted life years (QALY) accrued in each cohort. Subjects in each simulation experienced 2.03 (95% CI 1.94-2.12) allergic reactions and 1.04 (95% CI 0.97-1.11) episodes of anaphylaxis. The incremental cost per episode of anaphylaxis treated with epinephrine over the model horizon was $12,576 for EPN vs. EIA. If three double packs were prescribed each year, the incremental cost per episode of anaphylaxis treated rose to $18,728 for EPN.
Conclusions: Online cost differences between epinephrine autoinjectors are significant and do not correspond with incremental benefit.