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 L K 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 L K Tang⁹

Affiliations

¹ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
² Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
³ Population Allergy, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁴ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Monash Children's Hospital, Clayton, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁵ Monash Children's Hospital, Clayton, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
⁶ Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH; Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH; Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
⁷ Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
⁸ Health Economics and Policy Evaluation Research Group, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
⁹ Monash Children's Hospital, Clayton, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia. Electronic address: [email protected].

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

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.

Keywords: Desensitization; Egg allergy; Food allergy; Oral immunotherapy; Remission; Sustained unresponsiveness.