Cost-Effectiveness of Oral Immunotherapy for Egg Allergy According to Age of Therapy Commencement

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-03-01 DOI:10.1016/j.jaip.2024.12.005

Melanie Lloyd PhD , Jedidiah I. Morton PhD , Rachel L. Peters PhD , Paxton Loke PhD , Sarah Ashley PhD , Marcus S. Shaker MD, MS , Matthew Greenhawt MD, MBA, MSc , Zanfina Ademi PhD , Mimi L.K. Tang PhD

{"title":"Cost-Effectiveness of Oral Immunotherapy for Egg Allergy According to Age of Therapy Commencement","authors":"Melanie Lloyd PhD , Jedidiah I. Morton PhD , Rachel L. Peters PhD , Paxton Loke PhD , Sarah Ashley PhD , Marcus S. Shaker MD, MS , Matthew Greenhawt MD, MBA, MSc , Zanfina Ademi PhD , Mimi L.K. Tang PhD","doi":"10.1016/j.jaip.2024.12.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Egg oral immunotherapy (OIT) can induce desensitization or remission of egg allergy in children.</div></div><div><h3>Objective</h3><div>To determine the cost-effectiveness of OIT for raw egg allergy in school-age children compared with egg avoidance, and the most cost-effective age at which to commence treatment.</div></div><div><h3>Methods</h3><div>A decision-analytic Markov model estimated the health and cost outcomes of 1,000 children aged 4 years with egg allergy, comparing different ages of OIT commencement (ages 4-12, inclusive) versus ongoing egg avoidance. Years lived with egg allergy, egg tolerance or remission (natural and OIT-induced), and desensitization to egg were captured, with rates of allergic reactions and utility values assigned to each health state. Treatment effects were derived from published randomized clinical trials and meta-analyses. The main outcome was the incremental cost-effectiveness ratio (ICER) from the Australian health care payer perspective (costs in Australian dollars per quality-adjusted life-year [QALY] gained), with a 20-year time horizon, 5% annual discounting, and an AU $50,000/QALY willingness-to-pay (WTP) threshold.</div></div><div><h3>Results</h3><div>Without OIT, 858 children attained natural resolution before age 24. Under conservative assumptions, with OIT-induced remission set at zero and 84% achieving desensitization, ICERs were below the WTP threshold for treatment commencement at age 8 or older, with the smallest ICER observed at age 12 (AU $43,233/QALY; 95% CI, 32,025-73,350). However, the cost-effectiveness of OIT was achieved at all ages (ICER less than the WTP threshold) when OIT-induced remission increased to ∼40% of treated children.</div></div><div><h3>Conclusions</h3><div>Based on current published evidence, the cost-effectiveness of egg OIT improves with increased age of treatment commencement. Cost-effectiveness increases when the proportion of children achieving OIT-induced remission increases.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 619-629"},"PeriodicalIF":8.2000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213219824012431","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Egg oral immunotherapy (OIT) can induce desensitization or remission of egg allergy in children.

Objective

To determine the cost-effectiveness of OIT for raw egg allergy in school-age children compared with egg avoidance, and the most cost-effective age at which to commence treatment.

Methods

A decision-analytic Markov model estimated the health and cost outcomes of 1,000 children aged 4 years with egg allergy, comparing different ages of OIT commencement (ages 4-12, inclusive) versus ongoing egg avoidance. Years lived with egg allergy, egg tolerance or remission (natural and OIT-induced), and desensitization to egg were captured, with rates of allergic reactions and utility values assigned to each health state. Treatment effects were derived from published randomized clinical trials and meta-analyses. The main outcome was the incremental cost-effectiveness ratio (ICER) from the Australian health care payer perspective (costs in Australian dollars per quality-adjusted life-year [QALY] gained), with a 20-year time horizon, 5% annual discounting, and an AU $50,000/QALY willingness-to-pay (WTP) threshold.

Results

Without OIT, 858 children attained natural resolution before age 24. Under conservative assumptions, with OIT-induced remission set at zero and 84% achieving desensitization, ICERs were below the WTP threshold for treatment commencement at age 8 or older, with the smallest ICER observed at age 12 (AU $43,233/QALY; 95% CI, 32,025-73,350). However, the cost-effectiveness of OIT was achieved at all ages (ICER less than the WTP threshold) when OIT-induced remission increased to ∼40% of treated children.

Conclusions

Based on current published evidence, the cost-effectiveness of egg OIT improves with increased age of treatment commencement. Cost-effectiveness increases when the proportion of children achieving OIT-induced remission increases.

查看原文本刊更多论文

根据开始治疗的年龄划分鸡蛋过敏口服免疫疗法的成本效益。

背景：鸡蛋口服免疫治疗可诱导儿童鸡蛋过敏脱敏或缓解。目的：确定OIT治疗学龄儿童生鸡蛋过敏的成本效益与避免鸡蛋的成本效益，以及开始治疗的最具成本效益的年龄。方法：一个决策分析马尔可夫模型估计了1000名4岁的鸡蛋过敏儿童的健康和成本结果，比较了不同年龄的OIT开始（从4-12岁，包括）和持续的鸡蛋避免。对鸡蛋过敏、鸡蛋耐受/缓解（天然和油脂诱导）和对鸡蛋脱敏的生活年限进行了记录，并将过敏反应率和效用值分配给每种健康状态。治疗效果来源于已发表的随机临床试验和荟萃分析。从澳大利亚医疗保健支付者的角度来看，主要结果是增量成本效益比（ICER）（以每个质量调整生命年[QALY]获得的成本为澳元），时间跨度为20年，年折扣率为5%，支付意愿阈值为50,000澳元/QALY。结果：无OIT的858例患者在24岁前获得自然消退。在保守假设下，oit诱导的缓解为零，84%达到脱敏，≥8岁开始治疗的ICERs低于WTP阈值，最小的ICER在12岁时观察到（43,233澳元/QALY [95% CI: 32,025-73,350]）。结论：根据目前发表的证据，鸡蛋OIT的成本效益随着治疗开始年龄的增加而提高。当获得油肿引起的缓解的儿童比例增加时，成本效益就会增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.