A Diagnostic Algorithm Using Peanut SPT and Ara H 2 Sige Reduces Number of OFCs and Cost of Peanut Allergy Diagnosis in a Clinical Setting: a Cost Comparison Analysis.

Tim Brettig,Jennifer Koplin,Vicki McWilliam,Rachel Peters,Kirsten Perrett

Journal of Allergy and Clinical Immunology（2024）

Murdoch Childrens Res Inst | Univ Queensland

Cited 0|Views28

Abstract

Background: Peanut allergy prevalence is reported at 3% and consumes a significant volume of oral food challenges (OFC) in the diagnosis of food allergy. Compared to skin prick test (SPT) or sIgE to whole peanut, sIgE to peanut component ara h 2 has greater diagnostic accuracy. Two-step algorithms involving both SPT and ara h 2 sIgE demonstrate increased accuracy in diagnosis in modelled studies, resulting in fewer OFCs. We aimed to determine whether there is a similar reduction in OFCs in a clinical uptake of this two-step diagnostic algorithm compared to using peanut SPT alone and perform a cost comparison between these two approaches. Methods: In 2015, The Royal Children’s Hospital, Australia (RCH) implemented a clinical guideline using peanut SPT followed by sIgE to ara h 2 if the SPT was between 3 and 8mm and clinician is considering an OFC for a patient with suspected peanut allergy. We performed an audit of patients presenting to RCH allergy outpatient clinics for assessment of peanut allergy to determine the outcomes and potential reduction in need for OFC using the two-step algorithm. We used modelled data of the same patient cohort to estimate the number of OFCs that were avoided as a result of a high (≥1.0kUA/L) ara h 2 sIgE. A cost comparison was performed comparing the two-step algorithm to using peanut SPT alone. Costs were constructed based on unit prices from hospital admissions, medicare data and individual data on allergic reaction types, applying a health system perspective. Results: 8826 patients presented to RCH for peanut allergy assessment between May 2016 and August 2020. Of these, 9.2% proceeded to an OFC, with positive results seen in 20.1% and anaphylaxis in 1.1%. 42.0% (364/867) of patients with a SPT between 3-8mm followed the diagnostic algorithm appropriately. Of those who followed the diagnostic algorithm, there was a reduction of 27.8% in OFCs as a result of an elevated (>1.0kUA/L) ara h 2 result. The diagnostic algorithm pathway resulted in a 32.05% cost reduction compared to the modelled SPT-only pathway. Sensitivity analysis demonstrated that the number of patients proceeding to OFC gives greatest impact to the overall cost of diagnosis, rather than the cost of the OFC or ara h 2 itself. Conclusions: A combined algorithm incorporating peanut SPT followed by sIgE to ara h 2 resulted in a reduction in patients requiring oral food challenges. There is also a cost saving for this approach. There is a large proportion of patients that did not follow the algorithm, and this may relate to clinical history.

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【要点】：本研究通过比较使用花生皮肤点刺试验（SPT）和花生组分Ara H 2特异性IgE（sIgE）的两步诊断算法与仅使用花生SPT的诊断方法，发现两步算法能显著减少口服食物挑战（OFC）的数量和降低诊断成本。

【方法】：在2015年，澳大利亚皇家儿童医院（RCH）实施了一项临床指南，对疑似花生过敏的患者首先进行花生SPT，若结果在3至8毫米之间，则进一步进行Ara H 2 sIgE检测。通过审计RCH过敏门诊患者的数据，评估两步算法在减少OFC需求方面的效果，并使用模型数据估计避免了多少OFC。

【实验】：2016年5月至2020年8月，共有8826名患者至RCH进行花生过敏评估。其中9.2%的患者进行了OFC，20.1%得到阳性结果，1.1%出现过敏性休克。42.0%的SPT结果在3-8mm之间的患者正确遵循了两步诊断算法，其中由于Ara H 2结果升高（>1.0kUA/L），OFC数量减少了27.8%。两步算法路径相较于模型中的SPT单一算法，诊断成本降低了32.05%。敏感性分析显示，进行OFC的患者数量对诊断总成本的影响最大。