OBJECTIVES: Food allergy (FA) is a widely recognised public health issue. This systematic review (SR) investigated the economic and humanistic burden of FA, and the cost-effectiveness of treatments.

METHODS: We searched MEDLINE, Embase, National Health Service Economic Evaluation Database and International Health Technology Assessment databases (July 2023), supplemented by hand-searches of conference proceedings (2021–2022) and grey literature. Records were reviewed by two individuals; those reporting healthcare cost and resource use (HCRU) (n≥200, published in/after 2013), utility values (n≥200) or health-related quality of life (HRQoL) (n≥220, assessed using FAQLQ-PB/AF/PF) in children/adults with FA and their caregivers were eligible, as were economic evaluations of FA treatments (published in/after 2013). Study quality was assessed using the Drummond or Alberta Heritage Foundation for Medical Research checklists.

RESULTS: Fifty-five studies met the inclusion criteria: HCRU (n=25), HRQoL/utilities (n=26/5) and cost-effectiveness (n=5). Total cost burden was high, driven by medication use and physician visits. Indirect costs further increased economic burden, and high productivity costs (n=2) were observed ($14,732 CAD and $339.20 AUD, annually). Mean HRQoL observed among children and adults with FA (1.8–4.56; 3.2–5.41) was similar to their caregivers (1.78–3.8), highlighting that FA impacts the family. Utility values were limited (n=5) with only one study reporting caregiver utility, one using paediatric-specific measures and none using a FA-specific health utility instrument. Findings of cost-effectiveness studies of epicutaneous (n=2) and peanut oral immunotherapy (n=5) versus avoidance in peanut allergic children conflicted across differing contexts, economies, and healthcare perspectives.

CONCLUSIONS: FA has a high economic and humanistic burden, indicating a large unmet need for management strategies. Disease-specific health utility data are sparse and no disease-specific utility index exists. Given discrepancies in FA treatment cost-effectiveness, disease-sensitive methods to evaluate utilities in FA and inform future economic evaluations for decision-making are needed.