Health state utility values in children with peanut allergy and their caregivers: a UK vignette study

Peanut allergy is a common allergy in children, affecting the health-related quality of life (HRQoL) of the child and other members of the family. Demonstrating health state utility values (HSUVs) for children with peanut allergy is a requirement for reimbursement of treatments in health technology assessment, yet evidence is scarce relative to eliciting dose (ED, in mg peanut protein). We aimed to estimate utility values of children with peanut allergy and their caregivers, for four distinct health states defined by ED and guided by survey results: <150mg; ≥150–<300mg; ≥300mg peanut-only allergy; and ≥300mg poly-nut allergy (300mg corresponding to roughly one large Virginia peanut). An online survey investigating the impacts of peanut allergy was conducted, and 604 participants completed the survey across two waves between 2019 and 2020. Health-state vignettes (descriptions) were generated based on survey outcomes and validated via six semi-structured interviews with caregivers of children with peanut allergy, members of patient organizations, and two clinical experts. The resulting eight vignettes were valued by 100 members of the UK general public using the time trade-off (TTO) method to derive HSUVs. The estimated HSUVs (standard deviation) generated using TTO for the <150mg, ≥150–<300mg, ≥300mg peanut-only allergy, and ≥300mg poly-nut allergy ED categories were: 0.80 (0.24), 0.86 (0.21), 0.92 (0.18) and 0.88 (0.19), respectively, for children; and 0.82 (0.27), 0.89 (0.18), 0.93 (0.16) and 0.91 (0.17), for caregivers. We successfully generated HSUVs for children with peanut allergy and their caregivers for different ED categories, which may be used to inform economic modelling and reimbursement decisions. Our study provides supportive evidence of a potential association between ED and utility, highlighting the importance of treatments focused on desensitizing children with peanut allergy and providing long-term solutions to living with peanut allergy.