Cost-effectiveness analysis of probiotic peanut oral immunotherapy (PPOIT) versus placebo in Australian children with peanut allergy alongside a randomised trial

Li Huang; Kim Dalziel; Melanie Lloyd; Paxton Loke; Adriana C Lozinsky; Mimi Tang

doi:10.1136/bmjopen-2023-075521

Cost-effectiveness analysis of probiotic peanut oral immunotherapy (PPOIT) versus placebo in Australian children with peanut allergy alongside a randomised trial

BMJ Open. 2023 Dec 10;13(12):e075521. doi: 10.1136/bmjopen-2023-075521.

Authors

Li Huang¹, Kim Dalziel¹, Melanie Lloyd^{2

3}, Paxton Loke^{2

4}, Adriana C Lozinsky², Mimi Tang^{5

6}

Affiliations

¹ School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
² Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
⁵ Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia mimi.tang@rch.org.au.
⁶ Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.

Abstract

Objective: To compared the cost-effectiveness of coadministration of a probiotic adjuvant with peanut oral immunotherapy (PPOIT) with placebo (no treatment) in children with peanut allergy.

Design: Prospectively planned cost-effectiveness analysis alongside a randomised control trial.

Setting: The Royal Children's Hospital, Melbourne, Australia.

Participants: 56 children with peanut allergy aged 1-10 years at recruitment.

Intervention: A daily dose of probiotic Lactobacillus rhamnosus CGMCC 1.3724 (NCC4007) and peanut oral immunotherapy administered for 1.5 years.

Main outcomes measures: Costs were considered from a healthcare system perspective and included costs of treatment delivery and adverse events. Effectiveness outcomes included rate of sustained unresponsiveness (SU) and quality-adjusted life years (QALYs). The cost-effectiveness of PPOIT versus placebo was analysed using patient-level data. Time horizon was 10 years from commencement of PPOIT treatment, comprising 1.5 years of treatment (actual data), 4 years of post-treatment follow-up (actual data), and 4.5 years of extrapolation thereafter (modelling).

Results: Healthcare cost per patient over 10 years was higher for PPOIT compared with placebo ($A9355 vs $A1031, p<0.001). Over half of the per patient healthcare cost (53%) in the PPOIT group was attributable to treatment delivery, while the remaining cost was attributable to adverse events. Both measures of effectiveness were superior in the PPOIT group: the average SU rate over 10 years was 54% for PPOIT versus 6% for placebo (p<0.001); QALYs over 10 years were 9.05 for PPOIT versus 8.63 for placebo (p<0.001). Overall, cost per year of SU achieved was $A1694 (range $A1678, $A1709) for PPOIT compared with placebo, and cost per additional QALY gained was $A19 386 (range $A19 024, $A19 774).

Conclusions: Cost per QALY gained using PPOIT compared with no treatment is approximately $A20 000 (£10 000) and is well below the conventional value judgement threshold of $A50 000 (£25 000) per QALY gained, thus deemed good value for money ($A1= £0.5 approximately).

Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12608000594325; Post-results.

Keywords: HEALTH ECONOMICS; IMMUNOLOGY; PAEDIATRICS.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Arachis
Australia
Child
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Humans
Peanut Hypersensitivity* / therapy
Probiotics* / therapeutic use
Quality-Adjusted Life Years