Determining optimal prioritization system for food oral immunotherapy in a tertiary care setting
Monday, March 5, 2018
South Hall A2 (Convention Center)
Beatrice Paradis, Noémie Paradis, Jonathan Lacombe Barrios, MD, Kathryn Samaan, MD, Louis P. Paradis, MD FAAAAI, Jean Paradis, MD FAAAAI, Francois Graham, MD, Anne M. Des Roches, MD FAAAAI, Philippe Begin, MD, PhD, FRCPC, FAAAAI
RATIONALE: As oral immunotherapy makes its way to clinic, the high demand and initially limited offer will raise issues of access, especially in public healthcare systems. Given the low acceptability of first-come first-serve approaches, we sought to develop a prioritization algorithm that would be perceived as fair by patients and healthcare professionals.

METHODS: Various prioritization scenarios were submitted to an expert panel consisting of both healthcare professionals and end-users through an evolutive Delphi approach to determine consensual prioritization criteria. These were used as a base to compare the effect of various prioritization systems (first-come first-served, scoring, additive and waiting time ratio) on the OIT waiting list at our tertiary academic center.

RESULTS: Consensual prioritization criteria were idenfied by the panel of 25 experts after 3 iterations and included: number of food allergies, allergy to ubiquitous food, younger age and impact on quality of life. Correlation between prioritization systems were systematically low (Pearson R below 0.4) except for the additive and scoring systems. The waiting time ratio system was perceived as the most fair by the expert panel. The most frequent comment from experts was that this system offered the best balance between prioritizing severe food allergy cases and offering a fair chance to all applicants.

CONCLUSIONS: A prioritization system based on adjustment of waiting times using ratio for prioritized subgroups appears to be the most consensual approach to determine access to oral immunotherapy in the context of limited resources and high demand.