We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
The health and economic outcomes of early egg introduction strategies.
- Authors
Shaker, Marcus; Verma, Kanak; Greenhawt, Matthew
- Abstract
Background: Studies suggest early egg introduction (EEI) in the first year of life is associated with reduced risk of developing egg allergy. No US recommendations exist regarding optimally implementing EEI. Methods: Using simulation and Markov modelling over a 20‐year horizon, we explored optimal EEI strategies applied to US, European and Canadian populations, comparing screening of high‐risk infants (skin prick testing [SPT] or serum‐specific IgE[sIgE]) before introducing cooked egg at 6 months of life vs egg introduction at home, without screening, for all infants. Results: A no‐screen approach dominated egg SPT screening of high‐risk infants with early‐onset eczema. Base model per‐patient incremental costs of SPT were $6865 US dollars (USD), 6801 euros and $10 610 Canadian dollars (CAD). For egg sIgE screening in primary care settings, base model incremental costs were $16 722 USD, 18 072 euros and $28 193 CAD. As the simulation concluded 2.5% were egg allergic without screening vs 9.5%, 12% and 21.4% of children undergoing SPT, delayed introduction or sIgE screening. Incremental societal costs from screening reached $2 009 351 175 USD for SPT and $4 894 445 790 USD for sIgE testing. In sensitivity analyses, if the risk of reaction with initial egg ingestion was ≥22.5%, SPT before EEI became a preferred strategy. A no‐screen approach dominated both EEI of raw pasteurized egg and delayed cooked egg introduction approaches. Conclusions: Assuming initial reaction rates < 22.5%, a no‐screening EEI cooked egg approach has superior health and economic benefits in terms of number of egg allergy cases prevented and total healthcare costs vs screening testing.
- Subjects
EGGS; ALLERGIES; SIMULATION methods &; models; MARKOV processes; ALLERGY in children
- Publication
Allergy, 2018, Vol 73, Issue 11, p2214
- ISSN
0105-4538
- Publication type
Article
- DOI
10.1111/all.13565