Cost-effectiveness of oral immunotherapy for egg allergy according to age of therapy commencement

Melanie Lloyd; Jedidiah I Morton; Rachel L Peters; Paxton Loke; Sarah Ashley; Marcus S Shaker; Matthew Greenhawt; Zanfina Ademi; Mimi Lk Tang

doi:10.1016/j.jaip.2024.12.005

Cost-effectiveness of oral immunotherapy for egg allergy according to age of therapy commencement

J Allergy Clin Immunol Pract. 2024 Dec 13:S2213-2198(24)01243-1. doi: 10.1016/j.jaip.2024.12.005. Online ahead of print.

Authors

Melanie Lloyd¹, Jedidiah I Morton², Rachel L Peters³, Paxton Loke⁴, Sarah Ashley⁵, Marcus S Shaker⁶, Matthew Greenhawt⁷, Zanfina Ademi⁸, Mimi Lk Tang⁹

Affiliations

¹ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Australia; Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia.
² Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia; Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia.
³ Population Allergy, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁴ Allergy Immunology, Murdoch Children's Research Institute, Parkville, and Monash Children's Hospital, Clayton, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁵ Allergy Immunology, Murdoch Children's Research Institute; Department of Allergy and Immunology, Royal Children's Hospital; Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁶ Dartmouth Geisel School of Medicine, Departments of Medicine and Pediatrics, Hanover NH; Dartmouth Hitchcock Medical Center, Section of Allergy & Clinical Immunology, Lebanon, NH, United States.
⁷ Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, United States.
⁸ Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
⁹ Allergy Immunology, Murdoch Children's Research Institute; Department of Allergy and Immunology, Royal Children's Hospital; Department of Paediatrics, University of Melbourne, Parkville, Australia. Electronic address: mimi.tang@mcri.edu.au.

PMID: 39675524
DOI: 10.1016/j.jaip.2024.12.005

Abstract

Background: Egg oral immunotherapy can induce desensitization or remission of egg allergy in children.

Objective: To determine the cost-effectiveness of OIT for raw egg allergy in school-aged children compared to 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 1000 children aged four years with egg allergy, comparing different ages of OIT commencement (from ages 4-12, inclusive) versus ongoing egg avoidance. Years lived with egg allergy, egg tolerance/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 incremental cost effectiveness ratio (ICER) from the Australian healthcare payer perspective (costs in AU$ 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, n=858 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 ages ≥8, with the smallest ICER observed at age 12 (AU$43,233/QALY [95% CI: 32,025-73,350]). However, cost-effectiveness of OIT was achieved at all ages (ICER<WTP threshold) if OIT-induced remission increased to ∼40% of treated children.

Conclusions: Based on current published evidence, 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.

Keywords: Egg allergy; Food allergy; desensitization; oral immunotherapy; remission; sustained unresponsiveness.