Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

Objectives: To identify published economic evaluations of interventions aimed at preventing, diagnosing, or treating food allergies in children. Methods: We examined economic evaluations published from 2000 to 2019. Data analyzed included: food allergy type, study population/setting, intervention/comparator, and economic evaluation details. Quality assessment used reporting and economic modeling checklists. Two reviewers simultaneously undertook article screening, data extraction, and quality assessment. Results: 17 studies were included: 8 peanut allergy (PA) studies, 8 cow's milk allergy (CMA) studies, and 1 egg allergy (EA) study. All PA studies reported incremental costs per quality-adjusted life-year gained for diagnostic strategies, management pathways for peanut exposure, and immunotherapies. Immunotherapies rendered inconsistent cost-effectiveness results. CMA studies reported costs per symptom-free day or probability of developing CMA tolerance. Cost-effectiveness of extensively hydrolyzed casein formula for CMA treatment was consistently demonstrated. Early introduction of cooked egg in first year of life dominated all EA prevention strategies. Quality assessment showed average noncompliance for 3.5 items/study (range 0-11) for modeling methods and 3.4 items/study (range 0-8) for reporting quality. Key quality concerns included limited justification for model choice, evidence base for model parameters, source of utility values, and representation of uncertainty. Conclusion: Recent cost-effectiveness literature of interventions in PA, CMA, and EA is limited and diverse. Interventions for diagnosis and treatment of CMA and prevention of EA were generally cost-effective; however, results for PA were variable and dependent on effectiveness and utility values used. There is a need to expand economic evaluation of interventions for childhood food allergy and to improve methods and reporting.

Automated summary

The recent literature on cost-effectiveness of interventions in peanut allergy (PA), cow's milk allergy (CMA), and egg allergy (EA) is limited and diverse. Interventions for diagnosis and treatment of CMA, as well as prevention of EA, are generally cost-effective, while the results for PA vary depending on effectiveness and utility values used. There is a need for expanded economic evaluation of interventions for childhood food allergy, as well as improvement in methods and reporting.