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.
CONCLUSION: 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.