OBJECTIVES: Evaluation of the cost of care of peanut allergy (PA) among pediatric Medicaid-insured patients.

METHODS: This retrospective study used Medicaid data from Iowa, Kansas, Missouri, Mississippi, New Jersey, and Wisconsin (01/01/2007–03/31/2017). Patients were classified by age (0–3, 4–17 years) and condition: PA (with PA diagnosis and evidence of severe allergic reactions) and PA-free (without PA diagnosis). PA patients were matched 1:10 to PA‑free patients based on age, sex, race, health-plan type, and state. Comorbidities, all-cause healthcare resource utilization, and all-cause and asthma-related direct healthcare costs (2017 USD; public payer’s perspective) were analyzed.

RESULTS: In the 0–3 cohort, 1,294 PA patients were matched to 12,940 PA-free patients; in the 4–17 cohort, 1,245 PA patients were matched to 12,450 PA-free patients. The proportion of patients with PA‑associated comorbidities (asthma, atopic dermatitis/eczema, other food allergies, and allergic rhinitis) was higher in the PA versus PA-free patients in both age groups (all p<0.01); depression and anxiety were also significantly higher in the 4–17 cohort (both p<0.01). Compared to PA-free patients, PA patients had more emergency department (ED) visits per patient‑year (PPY) (incidence rate ratio [IRR]=2.03, 0–3 ; IRR=1.90, 4–17 cohort; both p<0.01), inpatient admissions PPY (IRR=2.14, 0–3 cohort; IRR=1.71, 4–17 cohort; both p<0.01), and days with outpatient services PPY (IRR=1.38, 0–3 cohort; IRR=1.27, 4–17 cohort; both p<0.01). PA patients incurred higher total healthcare costs versus PA-free patients: the incremental cost PPY was $2,559 total or $1,840 excluding asthma-related costs (0–3 cohort; both p<0.01), and $2,845 total or $1,844 excluding asthma-related costs (4–17 cohort; both p<0.01).

CONCLUSIONS: In pediatric PA patients, comorbidities, ED visits, inpatient admissions, days with outpatient services, and annual direct healthcare costs, regardless of asthma-related costs, were consistently higher versus matched PA-free patients in Medicaid population.