Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada
Abstract Background Until recently, immediate emergency department (ED) transfer after food-related anaphylactic reactions was recommended regardless of symptom resolution following use of an epinephrine autoinjector (EAI). We evaluated the cost-effectiveness of delayed ED transfer after EAI use in...
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BMC
2025-01-01
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| Series: | Allergy, Asthma & Clinical Immunology |
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| Online Access: | https://doi.org/10.1186/s13223-025-00951-w |
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| author | Yiwei Yin Moshe Ben Shoshan Marcus Shaker Matthew Greenhawt Kate M. Johnson |
| author_facet | Yiwei Yin Moshe Ben Shoshan Marcus Shaker Matthew Greenhawt Kate M. Johnson |
| author_sort | Yiwei Yin |
| collection | DOAJ |
| description | Abstract Background Until recently, immediate emergency department (ED) transfer after food-related anaphylactic reactions was recommended regardless of symptom resolution following use of an epinephrine autoinjector (EAI). We evaluated the cost-effectiveness of delayed ED transfer after EAI use in non-medical settings (watchful waiting) compared to immediate ED transfer among pediatric patients with food allergies in Canada. Methods We developed a probabilistic Markov model of individuals starting at age of one year who are at risk of severe food-related allergic reactions requiring epinephrine. We evaluated medical costs (in 2022 Canadian dollars) and quality-adjusted life years (QALY) of each strategy over a 20-year horizon. In the base case, we assumed a tenfold increase in food allergy fatality for patients under watchful waiting, which we increased to 100- to 1,000-fold in sensitivity analysis. The analysis was conducted from the Canadian healthcare system perspective with a 1.5% annual discount rate and a willingness-to-pay (WTP) threshold of $50,000 per QALY. Results Immediate ED transfer following EAI use resulted in a decreased risk of food allergy fatality of 9.2 × 10− 5 over 20 years, which is equivalent to < 1 fatality per 200,000 patient-years. Watchful waiting resulted in cost savings of $1,157 per patient and a QALY loss of 7.28 × 10− 4; an incremental cost per QALY saved of $1,589,854. The incremental cost per death prevented with immediate ED transfer was $12,586,613. Watchful waiting remained cost-effective in all sensitivity and scenario analyses, except under extreme increases in fatality risk of 500-fold and 1,000-fold. Conclusions Watchful waiting for symptom re-occurrence following EAI administration in non-medical settings is cost-effective. |
| format | Article |
| id | doaj-art-c945eeba275c4560af8b5f6a8567a280 |
| institution | Kabale University |
| issn | 1710-1492 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Allergy, Asthma & Clinical Immunology |
| spelling | doaj-art-c945eeba275c4560af8b5f6a8567a2802025-02-09T12:42:02ZengBMCAllergy, Asthma & Clinical Immunology1710-14922025-01-0121111110.1186/s13223-025-00951-wCost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in CanadaYiwei Yin0Moshe Ben Shoshan1Marcus Shaker2Matthew Greenhawt3Kate M. Johnson4Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British ColumbiaMcGill University Health CentreSection of Allergy and Immunology, Dartmouth-Hitchcock Medical CenterSection of Allergy and Clinical Immunology, Children’s Hospital Colorado, University of Colorado School of MedicineCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British ColumbiaAbstract Background Until recently, immediate emergency department (ED) transfer after food-related anaphylactic reactions was recommended regardless of symptom resolution following use of an epinephrine autoinjector (EAI). We evaluated the cost-effectiveness of delayed ED transfer after EAI use in non-medical settings (watchful waiting) compared to immediate ED transfer among pediatric patients with food allergies in Canada. Methods We developed a probabilistic Markov model of individuals starting at age of one year who are at risk of severe food-related allergic reactions requiring epinephrine. We evaluated medical costs (in 2022 Canadian dollars) and quality-adjusted life years (QALY) of each strategy over a 20-year horizon. In the base case, we assumed a tenfold increase in food allergy fatality for patients under watchful waiting, which we increased to 100- to 1,000-fold in sensitivity analysis. The analysis was conducted from the Canadian healthcare system perspective with a 1.5% annual discount rate and a willingness-to-pay (WTP) threshold of $50,000 per QALY. Results Immediate ED transfer following EAI use resulted in a decreased risk of food allergy fatality of 9.2 × 10− 5 over 20 years, which is equivalent to < 1 fatality per 200,000 patient-years. Watchful waiting resulted in cost savings of $1,157 per patient and a QALY loss of 7.28 × 10− 4; an incremental cost per QALY saved of $1,589,854. The incremental cost per death prevented with immediate ED transfer was $12,586,613. Watchful waiting remained cost-effective in all sensitivity and scenario analyses, except under extreme increases in fatality risk of 500-fold and 1,000-fold. Conclusions Watchful waiting for symptom re-occurrence following EAI administration in non-medical settings is cost-effective.https://doi.org/10.1186/s13223-025-00951-wAnaphylaxisWatchful waitingCost-effectiveness analysis |
| spellingShingle | Yiwei Yin Moshe Ben Shoshan Marcus Shaker Matthew Greenhawt Kate M. Johnson Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada Allergy, Asthma & Clinical Immunology Anaphylaxis Watchful waiting Cost-effectiveness analysis |
| title | Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada |
| title_full | Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada |
| title_fullStr | Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada |
| title_full_unstemmed | Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada |
| title_short | Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada |
| title_sort | cost effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in canada |
| topic | Anaphylaxis Watchful waiting Cost-effectiveness analysis |
| url | https://doi.org/10.1186/s13223-025-00951-w |
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