BACKGROUND:The economic burden of food allergy is large; however, costs specific to individuals with peanut allergy experiencing reactions to peanuts remain to be evaluated. As the prevalence of peanut allergy continues to increase in children, a better understanding of the cost of care is warranted. OBJECTIVE:To assess the cost of care of peanut allergy among privately insured and Medicaid-insured pediatric patients in the United States. METHODS:This retrospective matchedcohort study included patients aged 4-17 years from the Optum Health Care Solutions and Medicaid Claims databases (January 1, 2007-March 31, 2017. Patients were classified into 2 cohorts: peanut allergy (with peanut allergy diagnosis codes and reactions triggering health care resource utilization [HRU]) and peanut allergy-free (no peanut allergy diagnosis codes in claims). Peanut allergy patients were matched 1:10 to peanut allergy-free patients based on baseline covariates. Comorbidities including anxiety and depression, HRU, and direct health care costs were compared between cohorts and reported for both perspectives separately. RESULTS:Compared with peanut allergyfree patients (n = 30,840 privately insured; n = 12,450 Medicaid), peanut allergy patients (n = 3,084 privately insured; n = 1,245 Medicaid) had higher prevalence of asthma, atopic dermatitis/eczema, other food allergies, allergic rhinitis, depression, and anxiety (all P < 0.01). Peanut allergy patients had higher HRU per patient per year (PPPY), including 90% more emergency department

Background There is limited research demonstrating the real-world economic burden of peanut allergy (PA) in the United States. The Peanut Allergy Burden Study (PABS) is a cross-sectional quantitative survey designed to determine the real-world experience of patients and caregivers with PA. The objective of the study was to understand the real-world utilization of PA-related healthcare resources and the impact of PA on productivity. Methods Participants completed an online survey to examine the real-world 12-month and lifetime healthcare utilization and past week productivity impact of PA in children (as reported by caregiver proxy), adolescents with PA, adults with PA, and caregivers of children with PA. Results Healthcare resource use over the past 12 months was frequent for adults (n = 153), adolescents (n = 102), and children (as reported by caregivers) (n = 382) with PA. Patients and caregivers reported the following rates of PA-related utilization in the past 12 months: at least 3 regular allergist appointments (28.8%–39.3%), unscheduled allergist appointments (15.6%–18.3%), general practitioner appointments (16.7%–24.2%), over-the-counter (OTC) medication usage (28.5%–35.7%), and epinephrine autoinjector usage (17.7%–26.2%). Additionally, over half of patients and caregivers reported ≥1 PA-related emergency department (ED)/urgent care visit (57.5%–59.9%), overnight hospital admission (36.3%–47.4%), IV epinephrine use (37.2%–52.3%), or intubation (26.2%–39.8%) over the past 12 months for PA. Healthcare resource use was high among all groups. Regarding productivity, PA significantly impacted household work, schoolwork, and employed work for patients and caregivers. PA-related reactions also impacted school attendance of children with PA. Conclusion Many healthcare resources were utilized by patients with PA and there was a loss of productivity associated with PA for patients and caregivers. New treatments to prevent or lower the risk of PA reactions could potentially help reduce healthcare resource utilization and PA-related productivity loss among patients and their families, particularly for patients for whom avoidance as a treatment strategy has not been reliable.

The Peanut Allergy Burden Study (PABS) assessed the real-world burden of peanut allergy (PA) on patients and caregivers in the United States. METHODS: Adolescents 13-17-years-old with self-reported, providerdiagnosed PA participated in the PABS online survey. Medical and treatment history and the validated Pediatric Quality of Life Inventory PedsQL (scores 0-100, higher is better) were collected. Between-group analyses were conducted (chi square; t-test). RESULTS: Adolescents with PA (n5102) completed PABS; mean6SD age was 14.761.4 years, 55.9% were male, 62.8% were white. The mean PedsQL Total score was 48.8; mean subscale scores were: Physical (53.6), Emotional (43.0), Social (48.2), School (46.0), and Psychosocial (44.5). These scores were significantly below the scale scores from a general population of 8-16-year-olds (n>5900; range: 78.2-87.0) and exceeded the minimum clinically important difference (4.36-9.12 points). Adolescents experiencing ≥1 PA-related reaction in the past year had significantly lower PedsQL Total score (p50.008), as did those receiving clinician intervention for ≥1 PA reaction in the past year (p<0.001), those ''not at all'' to ''somewhat satisfied'' with current approaches to PA reaction prevention (p50.012), those saying PA limited their day-today life ''somewhat'' to ''completely'' (p50.013), or who reported a ''great'' to ''100% chance'' of not effectively dealing with a reaction (p<0.001). CONCLUSIONS: Adolescents with PA have substantially lower PedsQL scores than the general population of similarly aged individuals. PedsQL Total scores were significantly different between subgroups defined by recent allergic reaction/need for clinician intervention, satisfaction with reaction prevention, perceived limitations on day-today life, and concern about their ability to deal with a reaction.

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was English language peer-reviewed PE studies describing scoring tools to evaluate methodological quality. Results: A total of 23 pharmacoeconomic scoring tools met the inclusion criteria. Findings revealed that although checklists and recommendations exist for evaluating the HC-PE literature, quantitative approaches are lacking. The checklists number of items ranged from 8-40 and focused on assessing risk of bias, study quality, and reporting standards. The checklists were useful in assessing the quality and methodology of PE studies, however, only one tool assigned points to each item. There were two tools that categorized each domain into qualitative grades, while the others did not assign scores. Conclusions: Appraising the quality of HC-PE literature has become increasingly important for decision makers and those conducting systematic reviews. There is a lack of validation and variability in the criteria which is not weighted. The performance of an effective assessment requires qualitative as well as quantitative aspects. Future research will include the development of such tool.