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Ana o 3 sIgE and diagnostic algorithms reduce cost of cashew allergy diagnosis in children compared to skin prick test: a cost comparison analysis
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  • Tim Brettig,
  • Kim Dalziel,
  • Jennifer Koplin,
  • Thanh Dang,
  • Lars Lange,
  • Vicki Mc William,
  • Sakura Sato,
  • Savvas Savvatianos,
  • Kirsten Perrett
Tim Brettig
Population Allergy Group Murdoch Children’s Research Institute Parkville Australia

Corresponding Author:tim.brettig@mcri.edu.au

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Kim Dalziel
Health Economics Unit Centre for Health Policy The University of Melbourne Victoria Australia
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Jennifer Koplin
Population Allergy Group Murdoch Children’s Research Institute Parkville Australia
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Thanh Dang
Population Allergy Group Murdoch Children’s Research Institute Parkville Australia
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Lars Lange
St Marien-Hospital Bonn Bonn Germany
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Vicki Mc William
Population Allergy Group Murdoch Children’s Research Institute Parkville Australia
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Sakura Sato
Clinical Research Center for Allergy and Rheumatology National Hospital Organization Sagamihara National Hospital Kanagawa Japan
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Savvas Savvatianos
Allergy Department 2 nd Pediatric Clinic University of Athens Greece
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Kirsten Perrett
Population Allergy Group Murdoch Children’s Research Institute Parkville Australia
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Abstract

Background: In the absence of a clear clinical history of reaction, diagnosis of cashew allergy using skin prick tests (SPT) or cashew-specific IgE requires a high number of oral food challenges (OFC). By using Ana o 3 sIgE alone, or a two-step diagnostic algorithm using cashew sIgE followed by Ana o 3 sIgE, there is a reduced need for OFC. We aimed to perform a cost comparison for both of these approaches compared to cashew SPT alone. Methods: Pooled individual level data from 6 studies was used to determine diagnostic accuracy and OFC rate. Two studies used cashew SPT (n=567, 198 allergic), with 95% positive and negative predictive values of ≥12mm and <3mm. Four studies were included in the pathways for Ana o 3 sIgE alone or a 2-step algorithm incorporating cashew and Ana o 3 sIgE (n=271, 156 allergic). Cut-offs used were ≥8.5kUA/L and ≤0.1kUA/L for cashew sIgE and ≥0.35kUA/L and ≤0.1kUA/L for Ana o 3 sIgE. Costs were constructed based on unit prices from hospital inpatient admissions, expenses incurred by families, individual patient data on allergic reaction types and rates and adrenaline autoinjector carriage, applying a health system perspective. Results: Modelled data through the Ana o 3 pathway resulted in a 46.43% cost reduction (\euro307,406/1000 patients) compared to using cashew SPT alone (\euro573,854/1000 patients). The 2-step algorithm resulted in a 44.94% cost reduction compared to SPT alone (\euro315,952.82/1000 patients). Both the Ana o 3 pathway and 2-step algorithm resulted in a 79-80% reduction in OFCs compared to SPT. Conclusions: Using Ana o 3 as a standalone test for cashew allergy diagnosis or a 2-step algorithm incorporating cashew sIgE and Ana o 3 sIgE is accurate and results in a large reduction in both OFCs and health system costs compared to cashew SPT alone.
21 Apr 2022Submitted to Pediatric Allergy and Immunology
10 May 2022Reviewer(s) Assigned
04 Jun 2022Review(s) Completed, Editorial Evaluation Pending
13 Jun 2022Editorial Decision: Revise Major
20 Jun 20221st Revision Received
23 Jun 2022Review(s) Completed, Editorial Evaluation Pending
25 Jun 2022Reviewer(s) Assigned
13 Jul 2022Editorial Decision: Revise Minor
18 Jul 20222nd Revision Received
18 Jul 2022Review(s) Completed, Editorial Evaluation Pending
21 Jul 2022Editorial Decision: Accept
Aug 2022Published in Pediatric Allergy and Immunology volume 33 issue 8. 10.1111/pai.13839