Cost-effectiveness of nasal adrenaline in the treatment of anaphylaxis

BACKGROUND: Nasal adrenaline spray is a novel needle-free alternative for the emergency treatment of anaphylaxis. Evidence on its cost-effectiveness versus adrenaline auto-injectors (AAIs) is currently limited. This analysis evaluates the cost-effectiveness of the nasal adrenaline spray versus an AAI in individuals ≥ 30 kg (approximately 8 years of age) at risk of all-cause anaphylaxis in the United Kingdom (UK). METHODS: Markov cohort model was developed for the UK setting from a societal perspective over a lifetime horizon. Four health states captured the risks and consequences of anaphylaxis. Clinical inputs included the probability of initial and recurrent anaphylactic episodes, adrenaline carriage, whether used, administration accuracy and needle-related administration errors. Costs included product acquisition, training, emergency care, hospitalization, needle-related administration errors, and productivity loss. Outcomes were quality-adjusted life years (QALYs), with costs and benefits discounted at 3.5% annually. The impact of uncertainty was assessed using deterministic and probabilistic sensitivity analyses. RESULTS: In the base case, the nasal adrenaline spray was dominant versus the AAI, yielding 0.26 additional QALYs at a lower cost (-£681). Cost differences were mainly driven by product acquisition, hospitalization rates and productivity loss. Results were robust across scenario analyses but were sensitive to assumptions about adrenaline carriage and use. CONCLUSIONS: In the UK, the nasal adrenaline spray may be a cost-effective alternative to AAIs, largely due to assumed higher carriage and greater likelihood of use during anaphylactic episodes. Further real-world evidence is needed to validate these assumptions and their impact on cost-effectiveness.