Cost-Effectiveness of Stock Epinephrine Autoinjectors on Commercial Aircraft.
Allergic reaction
Anaphylaxis
Autoinjector
Cost-effectiveness
Food allergy fatality
Health state utility
In-flight medical emergency
Quality of life
Simulation
Value-based price
Journal
The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220
Informations de publication
Date de publication:
Historique:
received:
06
02
2019
revised:
02
04
2019
accepted:
22
04
2019
pubmed:
16
6
2019
medline:
6
10
2020
entrez:
16
6
2019
Statut:
ppublish
Résumé
In-flight food-allergic reactions are rare events, but given increasing reports, grass-root advocates have lobbied to replace aircraft emergency kit epinephrine ampules with autoinjectors. To evaluate the cost-effectiveness of stock epinephrine on commercial aircraft. We conducted a Markov model with microsimulation of food-allergic individuals over an 80-year time horizon to evaluate the cost-effectiveness of supplementing airline medical kits with epinephrine autoinjectors (eg, providing autoinjector twin-packs in addition to the epinephrine ampule in the medical kit), versus not doing so, using a per-plane annual value-based cost ceiling of $338 (the value-based ceiling for school stock epinephrine). We assumed that autoinjector availability reduced fatality risk by 10%. Equipping all commercial aircraft with autoinjectors cost $2,470,422/year ($0.08/passenger-at-risk), from a societal perspective and when distributed over all at-risk travelers. Over the model horizon, the supplemental autoinjector strategy cost $32,329.29 (standard deviation [SD], $4024.32) versus $32,326.70 (SD $4024.29), produced 26.8917 quality-adjusted life-years (QALYs) (SD, 2.9720) versus 26.8915 (SD, 2.9725), with a lower fatality rate (0.00012; SD, 0.01095 vs 0.00015; SD, 0.1225) versus the ampule-only strategy. The incremental cost-effectiveness ratio of supplemental airline epinephrine autoinjectors was $10,766/QALY in the base-case analysis. The supplemental model remained cost-effective at a willingness to pay threshold of $100,000/QALY if it produced a minimum 1.4% annual food allergy fatality risk reduction, and dominated if it lowered diversion risk or event-related medical care costs-per-event by 10%, respectively. Under base-case scenarios, an airline supplemental stock epinephrine model is cost-effective, with a high value-based cost-ceiling and low annual cost per passenger-at-risk of $0.08.
Sections du résumé
BACKGROUND
In-flight food-allergic reactions are rare events, but given increasing reports, grass-root advocates have lobbied to replace aircraft emergency kit epinephrine ampules with autoinjectors.
OBJECTIVE
To evaluate the cost-effectiveness of stock epinephrine on commercial aircraft.
METHODS
We conducted a Markov model with microsimulation of food-allergic individuals over an 80-year time horizon to evaluate the cost-effectiveness of supplementing airline medical kits with epinephrine autoinjectors (eg, providing autoinjector twin-packs in addition to the epinephrine ampule in the medical kit), versus not doing so, using a per-plane annual value-based cost ceiling of $338 (the value-based ceiling for school stock epinephrine). We assumed that autoinjector availability reduced fatality risk by 10%.
RESULTS
Equipping all commercial aircraft with autoinjectors cost $2,470,422/year ($0.08/passenger-at-risk), from a societal perspective and when distributed over all at-risk travelers. Over the model horizon, the supplemental autoinjector strategy cost $32,329.29 (standard deviation [SD], $4024.32) versus $32,326.70 (SD $4024.29), produced 26.8917 quality-adjusted life-years (QALYs) (SD, 2.9720) versus 26.8915 (SD, 2.9725), with a lower fatality rate (0.00012; SD, 0.01095 vs 0.00015; SD, 0.1225) versus the ampule-only strategy. The incremental cost-effectiveness ratio of supplemental airline epinephrine autoinjectors was $10,766/QALY in the base-case analysis. The supplemental model remained cost-effective at a willingness to pay threshold of $100,000/QALY if it produced a minimum 1.4% annual food allergy fatality risk reduction, and dominated if it lowered diversion risk or event-related medical care costs-per-event by 10%, respectively.
CONCLUSIONS
Under base-case scenarios, an airline supplemental stock epinephrine model is cost-effective, with a high value-based cost-ceiling and low annual cost per passenger-at-risk of $0.08.
Identifiants
pubmed: 31201119
pii: S2213-2198(19)30433-7
doi: 10.1016/j.jaip.2019.04.029
pii:
doi:
Substances chimiques
Bronchodilator Agents
0
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2270-2276Informations de copyright
Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.