O3258: Analysis of Costs of Undesignated Stock Epinephrine for Anaphylaxis at Summer Camps

Background: Anaphylaxis is potentially life-threatening sequelae of allergic reactions and requires immediate treatment with injectable epinephrine. Around 14 million children attend summer camps in the United States (US) each year, with 2.5% of these campers having multiple food allergies. However, less than half of these children bring their own epinephrine autoinjector to camp. Although previous studies have evaluated the cost-effectiveness of stock epinephrine in schools, there is a lack of research in summer camp settings. The objective of our study is to investigate the cost-effectiveness of stock epinephrine in summer camps.

Methods: A decision-analytic Markov model was created to evaluate the outcomes of anaphylaxis in children attending US residential summer camps. Four strategies were considered: 1) individual provided epinephrine only, 2) stock epinephrine only, 3) current practice, and 4) stock epinephrine + individual supplemental epinephrine. Individuals with anaphylaxis who received early epinephrine had a decreased risk of hospitalization.The model ran over ten weeks and used a societal perspective. One way and probabilistic sensitivity analyses were performed. Secondary analyses included cost per hospitalization avoided and the cost-effectiveness of nurse-drawn epinephrine solution for injection in place of epinephrine autoinjectors.

Results: The stock epinephrine strategy was found to be the least expensive and most effective ($2.80, 69.9 QALDs) (Table 1). When stock epinephrine was excluded from the analysis, the preferred strategy was individual provided epinephrine. One-way sensitivity analysis for this scenario demonstrated that the model was sensitive to the risk of severe allergy, the risk of anaphylaxis, the risk of hospitalization for anaphylaxis, costs associated with missing camp, and the number of campers each week. Two-way sensitivity analysis demonstrated that both the cost of epinephrine autoinjectors and the cost of hospitalization could change the preferred strategy. (Figure 1) In probabilistic sensitivity analyses, the individual provided epinephrine only strategy was preferred in 83% of model iterations at a threshold of $100,000/quality-adjusted life-years. Secondary analysis demonstrated that the individual provided epinephrine was the only strategy resulted in the highest number of hospitalizations for anaphylaxis. The current practice strategy cost $7,806 per hospitalization avoided. Stock-epinephrine + Individual provided epinephrine cost an additional $4,401. When camps used nurse-drawn epinephrine solution for injection, stock epinephrine + individual supplemental epinephrine was the least expensive strategy and most effective strategy ($7.49, 69.9 QALDs), favored in 98% of model iterations in probabilistic sensitivity analyses at a threshold of $100,000/quality-adjusted life-years.

Conclusion: Anaphylaxis is a rare but serious event that requires immediate treatment. Our study demonstrates that stock epinephrine injectors alone are the most cost-effective strategy to treat anaphylaxis in the summer camp setting and provides camps with strategies to consider when preparing for these life-threating events.