Patients with peanut allergy who see an allergist experience lower health care costs
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Key takeaways:
- Despite greater severity of disease, patients with peanut allergy experience lower total mean health care costs than those with other food allergies.
- Patients with peanut allergy who receive care from an allergist experience significantly lower total mean costs than those who do not see a specialist.
- Patients who see an allergist experience fewer hospitalizations, shorter stays, fewer ED visits and less EMS utilization than those who do not see a specialist.
Patients with peanut allergy who see an allergist vs. those who do not experience lower total health care costs and higher rates of epinephrine prescriptions, according to a retrospective observational study.
The data, published in The Journal of Allergy and Clinical Immunology: In Practice, also found that patients with peanut allergy experienced lower health care costs compared with patients with other food allergies.
“In late 2019, we had worked on a prior study that investigated peanut allergy-related health-services utilization through a large commercial claims database. Previously, we had shown what the total direct costs associated with a diagnostic claim for peanut allergy were and had shown differences between those with a claim for peanut allergy vs. non-allergic controls,” Matthew Greenhawt, MD, MBA, MSc, director of the food challenge and research unit at Children’s Hospital Colorado, told Healio.
“However, this left us wanting to know about differences in total direct medical costs between persons with claims for peanut allergy vs. other non-peanut food allergies, as well as if costs differed based on having seen an allergy specialist,” he continued. “This led to our present study.”
Using the IBM MarketScan Commercial Claims and Encounters Database, Greenhawt and colleagues analyzed records from 72,854 patients with peanut allergy (PA) and 166,825 non-peanut allergy food allergy controls (NPAFAC) who sought care between Jan. 1, 2010, and June 30, 2019.
Participants had a mean age of 11.9 years (standard deviation [SD], 12.1). Most were male, from the geographic south, urban and insured by a preferred provider or exclusive provider organization. Only 8.3% reported multiple food allergies.
Rates of usage
According to the researchers, 53.1% of the PA group and 31.6% of the NPACAC group had a claim for an anaphylaxis episode in the previous 12 months (P < .001). Also, 66.8% of the PA group and 43.8% of the NPAFAC group submitted a claim for epinephrine (P < .001).
However, 8.2% of the NPAFAC group and 7.6% of the PA group had submitted claims for antihistamine, which the researchers called a significant difference (P < .001).
Further, the PA group had significantly higher percentages for allergy services (59.8% vs. 54.5%; P < .001) and mean number of ED visits for allergic reactions and related services (0.16 vs. 0.13; P < .001) than the NPAFAC group.
PA patients with an allergist had a mean of 5.3 national drug codes (NDC) at baseline and 5.7 during the follow-up period, while those without an allergist had a mean of 4.7 at baseline and 5.4 during follow-up (both, P < .001).
Similarly, PA patients with vs. without an allergist had higher means for ICD-10 codes at baseline (8.9 vs. 7.9) and follow-up (10.5 vs. 10.2; both, P < .001). The PA patients with an allergist also had a mean total of 3.82 (SD, 7.69) visits.
The researchers said they further found significantly higher rates of epinephrine claims, mean epinephrine costs and proportions of patients with anaphylaxis episodes among the PA patients with an allergist compared with those without an allergist (all, P < .001).
Specifically, 8.4% of the PA group with an allergist and 6.6% of those without had antihistamine claims (P < .001), with a mean of 0.24 (SD, 1.12) claims for those with an allergist and 0.16 (SD, 0.89) for those without (P < .001).
Patients with PA who saw an allergist were prescribed an epinephrine autoinjector at a higher rate than those who did not see an allergist (69.9% vs. 63.3%; RR = 1.67; P < .001), leading to higher mean epinephrine costs.
Additionally, PA patients with vs. without an allergist experienced differences in ED visits (0.06 vs. 0.27; P < .001), urgent care visits (0.02 vs. 0.05; P < .001) and ambulance services (0.01 vs. 0.02; P < .001).
Costs of treatment
Patients with PA who had at least one visit with an allergist had $6,347 (SD, $18,974) mean total health care costs, while those without any visits had $8,270 (SD, $35,035), which the researchers called a significant difference (P < .001).
The patients who saw an allergist also had significant differences in hospitalizations (0.03 vs. 0.08; P < .001), average length of stay (4.01 vs. 5.01; P = .04), ED visits (0.38 vs. 0.66; P < .001) and EMS use (0.21 vs. 0.31; P < .001) than those who did not see an allergist.
With $1,834 (SD, $3,498) for the allergist group and $1,849 (SD, $3,380) for the group that did not see an allergist, the researchers called the mean total reaction-related health care costs similar.
Specific figures for those patients with vs. without an allergist included total medical costs ($703 vs. $1,067), pharmacy costs ($1,131 vs. $782), ED visit costs ($82 vs. $347) and urgent care costs ($1 vs. $5; all, P < .001).
Also, patients with peanut allergy did not have the highest total direct costs of all the allergens, though peanut and tree nut allergy had the highest rates of epinephrine claims, the highest number of ED claims and total costs related to ED claims compared with other allergens. These results were not surprising, Greenhawt said, but others were.
“I was pleasantly surprised that total direct medical costs were significantly lower in persons with a claim for peanut allergy who also had an allergist visit vs. those with a claim for peanut allergy who have not seen an allergist, and that these total direct costs were lower across the board for other critical facets of medical care, including hospital, ED and EMS costs,” he said.
“What is more remarkable is that these cost savings were achieved among a group of patients with higher disease severity. The peanut allergic patients with an allergy visit had higher rates of epinephrine claims (ie, prescriptions filled), mean epinephrine costs and more claims for peanut anaphylaxis than the peanut allergic patients without an allergist visit,” he continued. “This is reassuring that we are providing high-value care as allergy specialists.”
Conclusions
These findings indicate that patients with PA potentially have higher disease severity than patients with NPAFAC, the researchers said, though patients with PA experienced lower total mean costs.
“This helps reinforce the importance of and need for specialty-trained expert care for very niched conditions such as food allergy. While we as allergy specialists are well-aware of our value and importance in caring for these patients, this is nice objective validation of the extent to what we can do as a specialty,” Greenhawt said.
“The take-home message is that the allergist is here to help care for these patients, and these data suggest we can play a significant role in cost-containment and related outcomes, even with patients who have more severe disease,” he added.
Also, the researchers said that allergist care may be associated with overall cost containment even though these patients may experience higher acuity. The researchers called for additional work to understand the factors behind these differences in costs.
“We have interest in better understanding the factors responsible for the lower costs between the peanut/food allergic patients with and without an allergist visit, and to better determine: if these effects are present with other allergic diseases; the duration to which allergy specialty care may leverage lower total medical claims costs; and the impact of food allergy treatments on these costs,” Greenhawt said.
Perspective
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When it comes to children with peanut allergies, expert specialty care reduces ED visits and lowers overall health care costs by around $2,000 per child, according to this study.
In fact, children whose peanut allergies are managed by allergy specialists are less likely to be hospitalized, have shorter hospital stays when they are admitted, visit the ED less and use fewer emergency medical services overall.
Although the study doesn’t delve into why, it echoes similar findings in pediatric asthma care: specialists can better equip parents with the knowledge they need to prevent, spot and manage severe reactions, including anaphylaxis. This drives down costly emergency-related services like ED and urgent care visits, as well as other health care costs.
Interestingly, this is true even when accounting for the fact that these allergists treat the sickest children. These are the kids who are more likely to suffer anaphylaxis and more likely to carry prescriptions for epinephrine and other medications. The more severe the allergy, the more costly you would expect the care to be. Instead, the study finds the opposite is true when allergy specialists are involved.
Although this appears counterintuitive, it comports with what we see every day. Pediatric allergists have developed a highly skilled level of expertise in this ever-evolving and nuanced area of pediatric care. It is simply impossible for pediatricians to keep up with the latest in allergy and immunology research, and the study confirms that expert care matters when it comes to lowering costs.
Perspective
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We see many underserved patients not getting access to allergists, and this is a major concern. They often then do not get a diagnosis and management plan and then have reactions and are seen in the ED.
So, how can we improve access to care? How can we see kids with Medicaid coverage faster? Or rural children? Can we leverage telehealth? We need to find a way. We also need to support generalists who manage food allergy for people who cannot get access to a specialist.
Next, we need to develop interventions to improve access to allergists and improve generalists’ management to see if we can improve care and decrease costs.
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