Cost-effectiveness of Bystander Epinephrine in Community Anaphylaxis
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Marcus S. Shaker, MD MS FAAAAI, David Corbin, MD, Matthew Shaker, MS, Susan Shaker, BA
RATIONALE: Epinephrine autoinjectors provide the most effective treatment for anaphylaxis but community availability is generally limited to individuals with previously identified risk factors. METHODS: A mathematical model of incident venom anaphylaxis was used to estimate the cost per life saved from bystander epinephrine use. Model inputs included the prevalence of stinging insect hypersensitivity, the US census population estimate, and the number of deaths from hymenoptera stings reported to the Centers for Disease Control and Prevention. Published costs of epinephrine autoinjectors were abstracted. The model assumed complete protection from early bystander epinephrine administration and a 1% annual risk of a hymenoptera sting in the general population. RESULTS: In the United States, 987 hymenoptera venom associated deaths were reported between 1999-2015. Deaths from venom anaphylaxis were uncommon. The annual risk of fatal venom anaphylaxis after a sting in an allergic individual was 0.38%. Treating venom associated community anaphylaxis with bystander epinephrine cost $272 (95%CI, $201-$343) per episode treated. The cost of preventing one venom-associated death using bystander epinephrine was $71,519 (95% CI, $52,763 - $90,100) assuming a 0.5% prevalence of hymenoptera hypersensitivity. CONCLUSIONS: Although federal law restricts the sharing of epinephrine autoinjectors this cost-effective practice could provide improved emergency access to this life-saving intervention.