Real World Data Of Canadians Living With Hereditary Angioedema: Part 1‐ Demographics: 524

Abstract

Marcus S. Shaker, MD MS FAAAAI, and Matthew J. Greenhawt, MD MBAMSc; Dartmouth-HitchcockMedical Center, Lebanon, NH, Children’s Hospital Colorado, Aurora, CO. RATIONALE: Unjustified cost variation in self-injectable epinephrine auto-injectors may represent a barrier to community anaphylaxis management. The average retail price for autoinjectors has increased from < $100 prior to 2010, to > $600 for some devices. Value-based pricing is a method of drug pricing where the drug cost is based on the magnitude of benefit it delivers, and can provide a useful benchmark for rational epinephrine autoinjector costs. We used simulation and cost-effectiveness analysis to define value-based pricing of epinephrine auto-injectors. METHODS: Markov simulations of peanut allergic children with or without personal epinephrine were evaluated over extended time horizons to evaluate cost-ceilings for value-based epinephrine prices. Children without auto-injectors assumed 10-fold to 100-fold fatality risk increases in sensitivity analysis. Costs were evaluated from a societal perspective. Cost-effective care was defined as care costing <$100,000/quality of life adjusted year (QALY). RESULTS: The value-based price for epinephrine based on 10-fold fatality risk differencewas $34.51 for an auto-injector twin-pack, assuming a ceiling for an incremental cost effectiveness ratio (ICER) of $100,000/ QALY.At a 100-fold fatality risk difference the value-based pricewas $378 per twin-pack. However, at a market cost of $635 per twin-pack the autoinjector ICER was $1,782,439 per QALY, which would not be considered within a value-based cost range. CONCLUSIONS: In a simulation of peanut-allergic children, valuebased epinephrine cost $34.51 $378.18 per twin-pack, even at exaggerated fatality risks. This suggests some auto-injector prices are not costeffective in preventing food allergy fatalities.