Food allergies show substantial economic impact on families, stakeholders

Although the impact varies by country and by type, food allergies come with substantial monetary costs for families and other stakeholders, according to study results.

“While other aspects of food allergy have been widely studied, little research has been conducted exploring the economic burden and impact of food allergies,” Andrew T. Fong, MD, MHLM, pediatric registrar at The Children’s Hospital at Westmead in Sydney, Australia, said during the presentation at European Academy of Allergy and Clinical Immunology Hybrid Congress.

Based on the PRISMA guidelines for Scoping Reviews and with costs converted to euros, the researchers found that childhood food allergy costs total 22.8 billion euros a year in the United States, or 3,849 euros per child per year. Yet caregivers reported that they would be willing to pay a maximum of 3,224 euros per year per child for food allergy management.

“The change from delayed to early introduction of food allergens has been shown to reduce the development of food allergies, and it is cost-effective to do so without screening,” Fong said, although he noted that it is not economically viable to screen all infants before introducing potential allergens to them.

Among high-risk children, for example, the incremental costs for preventing a single allergic reaction to peanuts include 18,762 euros for skin prick testing and 65,338 euros for serum IgE testing. Also, SPT yielded false positives in approximately 3.4% of all identified peanut allergy cases.

“Compared to age- and sex-matched controls, the total incremental costs associated with peanut allergy per person was 400 euros each year,” Fong said. “This was higher for those with a history of anaphylaxis and those prescribed an adrenaline autoinjector.”

When atopy-matched, total annual incremental health care costs associated with peanut allergy were 304 euros.

The researchers also found that the cost-effectiveness of management strategies for cow’s milk protein allergies differ by health system. Some countries, according to the researchers, have found that initial management via extensively hydrolyzed formula with probiotic Lactobacillus rhamnoses GG was the most cost-effective strategy.

Adrenaline autoinjectors have a high cost per use, the researchers further said, requiring a balance between cost-effectiveness and adverse outcomes. When hospitalization and fatality risks are considered and universal carriage and appropriate use are assumed, personal adrenaline has a maximum value-based price of 45 euros per device.

Patients with a history of anaphylaxis experienced additional incremental costs of 794 euros, whereas those prescribed an adrenaline autoinjector had additional incremental costs of 470 euros.

“Consideration of stocked adrenaline devices in schools may also be a cost-effective strategy,” Fong said, as the researchers additionally noted that 48% of children at risk for anaphylaxis may not carry a designated adrenaline autoinjector.

Varying health care structures and costs of living make comparisons of health care costs between countries difficult, the researchers wrote. However, they found that 31% of the direct out-of-pocket costs borne by families in the U.S. were related to additional food costs.

Also, the costs of food, travel to appointments and medications were 8,845 euros for households in Canada with individuals with food allergies, compared with 7,156 euros for those households without individuals with food allergies.

In Sweden, households with allergies to milk had 8,164 euros in costs, those with allergies to egg had 3,961 euros in costs, and those with allergies to wheat had 4,792 euros in costs.

As for immunotherapy, the researchers said, costs need to be balanced between immediate benefits such as protection from anaphylaxis and long-term benefits such as sustained unresponsiveness.

“When evaluating a value-based cost for immunotherapy, the annual cost of treatment could not exceed approximately 1,200 euros inclusive of clinician visits to be cost-effective,” Fong said.

Although commercial forms of immunotherapy are yet to be cost-effective, the researchers found that there is some evidence that noncommercial forms are cost-effective while improving quality of life.

Despite differences based on country and type of food allergy, the researchers concluded, there is a pattern of significant costs for those living with food allergy and for those involved in their treatment.