Evaluating the Cost-Effectiveness of Nasal Adrenaline Spray vs. Adrenaline Autoinjector for Treatment of Anaphylaxis: A Cost-Utility Modeling Approach
Author(s)
Shuaib Nasser, MB BS, MA, MD, FRCP1, Luca Bottazzi, MSc2, Andrea Lang, PhD2, Rebecca Skou, MSc3, Anne Danø, PhD4, Peter Carlqvist, BSc, MSc, PhD2.
1Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom, 2Nordic Market Access NMA AB, Stockholm, Sweden, 3ALK, Hørsholm, Denmark, 4Inspiria, Rungsted Kyst, Denmark.
1Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom, 2Nordic Market Access NMA AB, Stockholm, Sweden, 3ALK, Hørsholm, Denmark, 4Inspiria, Rungsted Kyst, Denmark.
OBJECTIVES: Adrenaline auto-injectors (AAIs), while effective, face barriers that limit their use, prompting the development of alternative administration routes. An innovative solution is a nasal adrenaline spray, which offers a ready-to-use and needle-free alternative. Its administration may improve carriage and likelihood of timely use during emergencies. The nasal adrenaline spray was recently approved in the US and Europe for the emergency treatment of anaphylaxis. Given its novelty, cost-effectiveness data remain limited. This study aimed to develop a cost-utility model to assess the cost-effectiveness of nasal adrenaline spray compared to AAIs in managing anaphylaxis.
METHODS: A Markov cohort model was developed to capture events of anaphylactic shock in the UK healthcare context over a lifetime horizon. The target population included adults and children weighing ≥30 kg at risk of anaphylaxis. Clinical inputs included the risk of anaphylaxis in the first and subsequent years, usage probability of an adrenaline product, differences in clinical outcomes when adrenaline is not administered, and adverse events. Cost inputs encompassed product acquisition, emergency department visits, hospitalisation, training, adverse events, and indirect costs.
RESULTS: The model captured differences between the nasal adrenaline spray and an AAI, highlighting the potential benefits of the intranasal route. Results indicated that the use of the nasal adrenaline spray led to cost savings and health gains of 0.1-0.4 quality-adjusted life years (QALYs). These outcomes were driven by the assumptions regarding improved usability, portability, and accessibility of intranasal adrenaline during anaphylaxis. Limited empirical data supporting these assumptions was acknowledged as a limitation.
CONCLUSIONS: This is the first cost-utility model developed to assess the cost-effectiveness of an adrenaline nasal spray versus an AAI for the emergency treatment of anaphylaxis in a UK setting. The analysis predicts that intranasal adrenaline may represent a cost-effective alternative due to its novel and potentially more accessible route of administration.
METHODS: A Markov cohort model was developed to capture events of anaphylactic shock in the UK healthcare context over a lifetime horizon. The target population included adults and children weighing ≥30 kg at risk of anaphylaxis. Clinical inputs included the risk of anaphylaxis in the first and subsequent years, usage probability of an adrenaline product, differences in clinical outcomes when adrenaline is not administered, and adverse events. Cost inputs encompassed product acquisition, emergency department visits, hospitalisation, training, adverse events, and indirect costs.
RESULTS: The model captured differences between the nasal adrenaline spray and an AAI, highlighting the potential benefits of the intranasal route. Results indicated that the use of the nasal adrenaline spray led to cost savings and health gains of 0.1-0.4 quality-adjusted life years (QALYs). These outcomes were driven by the assumptions regarding improved usability, portability, and accessibility of intranasal adrenaline during anaphylaxis. Limited empirical data supporting these assumptions was acknowledged as a limitation.
CONCLUSIONS: This is the first cost-utility model developed to assess the cost-effectiveness of an adrenaline nasal spray versus an AAI for the emergency treatment of anaphylaxis in a UK setting. The analysis predicts that intranasal adrenaline may represent a cost-effective alternative due to its novel and potentially more accessible route of administration.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE438
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)