Care by an allergist is associated with lower overall health care costs for US children with peanut allergy, new research has found.
In a study published in the Journal of Allergy and Clinical Immunology: In Practice, lead researcher Matthew Greenhout, MD, professor of pediatric allergy and immunology at the University of Colorado School of Medicine, and his co-researchers found that annual health care costs are significantly higher among children who did not receive care from an allergist for peanut allergy (PA) compared to those who did.
“One of the results of this study is that these data show that for peanut-allergic children, care from an allergy specialist can save money. This is important for payers to realize.”
Use of data to track costs
In this and previous research, Greenhout worked to “build a story about why peanut allergy is important to treat, why the FDA should approve products for treatment, and why insurance companies should pay for these products.”
Greenhawt and his co-researchers used specific diagnosis codes from IBM MarketScan Commercial Claims and Encounters data collected between January 2010 and June 2019 to demographically match a total of 72,854 patients with peanut allergy and 166,825 patients with peanut-free food allergy controls (NPAFAC). Outcomes were measured and compared for 12 months before and after the first claim date.
Among more than 72,000 people with PA, nearly 54% had one or more visits to an allergist. Those with PA who received care from an allergist, compared with those who did not receive care from an allergist, received epinephrine at significantly higher rates and also had higher rates of epinephrine insurance claims, costs for epinephrine and number of cases of peanut anaphylaxis.
Greenhawt and his co-investigators found that total health care costs were higher in the NPAFAC group than in the PA group. Among those with PA, total health care costs were significantly lower in those who received care from an allergist compared to those who did not—$6,347 versus $8,270.
Unintended economic consequences
“We were impressed but not surprised to see that allergists were dealing with children who had more epinephrine-related claims,” Greenhout says. “We think this is a sign of a higher severity of the disease. But it was interesting to see that even in the peanut allergy group, despite markers that the children had a higher burden of disease, receiving care from an allergist still resulted in cost savings compared to those who did not see an allergist .
Greenhout emphasizes that the health economics and health care utilization associated with food allergy diagnosis and reaction treatment are understudied, and that he hopes data like this can help demonstrate the high value associated with food allergy care. the allergist for food allergy, specifically peanut allergy.
“For example, if you look at anaphylaxis, those are very expensive admissions,” Greenhout says. “And I’m not suggesting that such admissions don’t happen even though someone with a peanut allergy is under the care of an allergist.” But this study provides evidence that for people with peanut allergy, specialty allergy care is cost-saving compared with no specialist involvement, and that provides value to both payers and patients.
One limitation of the data in this study is that it was not stratified by type of insurance plan, type of deductible, or number of special visits allowed by the plan. However, Greenhout notes that this is an area for further study to better understand how specialty allergy care can be provided.
“We want to make sure that allergists are central to the care of food allergy patients,” says Greenhout. “Every year there are cuts in reimbursement and we are given fewer resources to solve the same or more problems. This is a study that can provide evidence that the choices a payer makes about what services to cover can have unintended economic consequences.