An economic evaluation of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis.
BACKGROUND
Mild (cutaneous) venom anaphylaxis is the most common presentation of systemic venom hypersensitivity during childhood. Guidelines recommend prophylactic self-injectable epinephrine for children with mild venom anaphylaxis. However, progressive venom-associated reactions are uncommon in this population.


OBJECTIVE
To characterize the cost-effectiveness of prophylactic self-injectable epinephrine in mild childhood venom anaphylaxis from a societal perspective.


METHODS
Cohort simulations were used, and the base case was represented by a 6-year-old child with a history of mild venom-associated anaphylaxis. Long-term survival was modeled using age-adjusted mortality from the 2002 U.S. life tables together with the risk of venom-associated mortality. Model assumptions included market costs of self-injectable epinephrine; the prevalence of venom allergy; US census estimates; venom-associated fatality estimates by the Joint Council of Allergy, Asthma, and Immunology (at least 40 deaths per year); and venom-associated mortality statistics from January 1, 1999, to December 31, 2003, provided by the Centers for Disease Control and Prevention.


RESULTS
The incremental cost of prophylactic self-injectable epinephrine for mild childhood venom anaphylaxis was $469,459 per year of life saved ($6,882,470 per death prevented). In sensitivity analyses, the strategy was only cost-effective when the annual venom-associated fatality rate exceeded 2 per 100,000 persons at risk.


CONCLUSIONS
Use of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis is not cost-effective if the annual venom-associated fatality rate is less than 2 per 100,000 persons at risk.
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. marcus.shaker@dartmouth.edu
Marcus S
MS
Shaker
D000707:Anaphylaxis / Q000517:prevention & control*; D001514:Bee Venoms / Q000009:adverse effects*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D004837:Epinephrine / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D012646:Self Administration
D001514:Bee Venoms; D001993:Bronchodilator Agents; D004837:Epinephrine