Cost-effectiveness of Implementing a Pediatric Anaphylaxis Algorithm

There is increasing evidence that the majority of pediatric patients presenting with anaphylaxis do not require prolonged observation. We aimed to evaluate the cost-effectiveness of implementing an anaphylaxis algorithm that reduces emergency department (ED) observation time for low-risk patients and provides families with a free epinephrine auto-injector. Pre- and post-intervention data from a pediatric hospital implementing this algorithm and additional variables from the literature were incorporated into a decision-analytic cost-utility model from a hospital perspective. We modeled an algorithm providing all individuals with a free epinephrine auto-injector —the most expensive scenario for the hospital. All parameters were varied based on published ranges, or if no ranges were available, ±15% of the base value. The primary outcomes were the effect on direct hospital costs and the incremental cost-effectiveness ratio (ICER) expressed in 2018 USD per disability-adjusted life year (DALY) averted. The model was subjected to one-way sensitivity and probabilistic uncertainty analyses. For every 1000 patients presenting to the ED with anaphylaxis, use of this algorithm would reduce $208,211 in hospital costs and avert 0.3 DALYs, resulting in an ICER of $692,721 per DALY averted. Results were unchanged in one-way sensitivity analysis. In probabilistic uncertainty analysis, algorithm implementation was cost-effective 95.6% of the time. Reducing ED observation time decreases hospital costs, hospital charges, and DALYs due to anaphylaxis and being in the hospital. This intervention remains cost-effective despite the added cost of giving all patients a free epinephrine auto-injector.