Peanut Allergy Healthcare Costs High

Ingrid Hein

November 21, 2019

Medical claims are twice as high for people who have received treatment for a peanut allergy as for those who have not, and for people with a diagnosis of peanut allergy, those claims are 10 times as high, findings from a new study show.

"There's a high burden of disease with peanut allergy," said lead researcher Marcus Shaker, MD, from the Dartmouth Geisel School of Medicine in Lebanon, New Hampshire.

However, two therapies that will be "available soon" — a peanut allergy tablet and epicutaneous peanut therapy — will likely reduce costs and prevent hospitalizations, lowering the burden of peanut allergy, he reported.

"If these are approved and provided to patients, there could be significant cost-saving downstream effect," Shaker told Medscape Medical News.

For their study, he and his colleagues identified patients who received treatment for peanut allergy between January 1, 2011 and October 1, 2015 from the IBM MarketScan Commercial Claims and Encounters Database. The findings were presented in a poster at the American College of Allergy, Asthma & Immunology 2019 Annual Scientific Meeting in Houston.

All patients were younger than 65 years, and the mean age of the cohort was 10.5 years. All were enrolled with the insurer for 12 months before and 12 months after the first peanut-allergic claim.

The researchers matched 41,675 patients with a peanut-related claim or a peanut allergy diagnosis for age, sex, geographic region, and insurance plan type with 41,675 control subjects with no claims for or diagnosis of peanut allergy. "The matching was fairly extensive," Shaker explained.

The discrepancies between the two groups were significant across the board.

All-cause annual healthcare costs were higher for people in the allergy group than for those in the control group ($6436 vs $3493; P < .001).

Although not all claims were related to peanut allergy, patients with a peanut allergy tend to be hospitalized more frequently than those without, and to have more comorbidities, Shaker explained.

In fact, rates of asthma were higher in the allergy group than in the control group (35.6% vs 0.2%; P < .001), as were rates of atopic dermatitis (16.0% vs 0.4%; P < .001) and allergic rhinitis (43.1% vs 6.0%%; P < .001).

Annual healthcare costs related to peanut allergy were almost tenfold higher for those in the allergy group than for those in the control group ($1490 vs $159; P < .001). Epinephrine accounted for a part of those costs.

"Peanut-allergic patients are spending a big amount at the pharmacy," said Shaker. The amount spent by people in the allergy group was more than double that of those in the control group ($1434 vs $661; P < .001). And the average spent by peanut-allergic patients on epinephrine auto-injectors alone was $608.

Children in the allergy group were significantly more likely to visit a pediatrician than those in the control group.

Table. Pediatrician Visits
Age Group Allergy Group, % Control Group, % P Value
0–3 years 85 79 <.001
4–11 years 79 68 <.001
12–18 years 64 50 <.001

In the allergy group, mean costs for hospitalization were $7976 and for visits to the emergency department were $1214.

The researchers were unable to establish an association between hospital visits and peanut allergy because a hospitalization or emergency department visit could be unrelated to peanut allergy. "It's hard for us to know exactly all the costs that are due to peanut allergy," Shaker acknowledged.

High Hopes for Immunotherapy

The team was surprised to find that 36% of people in the allergy group experienced an anaphylactic reaction. "Most of the literature has rates between 6% and 45%, and usually closer to 6%," he said.

What these data tell us is that we need to treat peanut allergy at "both ends of the lever," he said. "How do we prevent it in the first place and how do we treat it?"

When immunotherapy for peanut allergy is initiated after a skin prick test, not an oral challenge, "some of the therapies out there may cause more reactions than they prevent," Shaker explained.

He pointed to a meta-analysis and systematic review of oral immunotherapy for peanut allergy performed by a research team in Canada.

After looking at 12 trials with 1041 patients, the researchers reported that although immunotherapy is effective for desensitization, the rate of anaphylaxis and allergic reactions was higher in patients on oral immunotherapy than in those taking placebo or avoiding peanut.

The Canadians conclude that safer peanut allergy treatment approaches are needed, which "the new FDA-approved therapies may provide," Shaker reported.

One problem is that patients are often screened for peanut allergy even before they are introduced to peanut, which might be leading to more treatment than necessary. "We need to be sure of the diagnosis and look at the degree of impairment," he pointed out.

That situation was exemplified in another poster presented at the meeting by Katherine Tison, MD, from the Emory University School of Medicine in Atlanta.

She described a case of peanut sensitivity identified with blood and skin prick tests, but oral testing showed that the patient was not allergic.

"We performed an oral food challenge, and he passed with only a small rash on his face, which resolved itself," Tison explained. "That showed he was sensitive to peanut, but not allergic."

This shows that an oral food challenge should be used to determine if a child is truly allergic, especially prior to starting oral immunotherapy treatment, which was being considered for this child. A sensitivity shown through a skin prick or blood test is not enough to diagnose a food allergy," she added.

"If you have someone who has many emergency department visits and frequent epinephrine use, they may be a perfect candidate for oral immunotherapy." But for someone who hasn't had any reactions and can successfully avoid the food they are allergic to, "you may not want to do that," she suggested.

"We're at an exciting point in food allergy. The story is not completely written," Shaker concluded. "We'll have to see where it takes us in 2020."

American College of Allergy, Asthma & Immunology (ACAAI) 2019 Annual Scientific Meeting: Posters P302 and M312.

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