January 13, 2015

The Impact of Double-Blind Placebo-Controlled Food Challenge (DBPCFC) on the Socioeconomic Cost of Food Allergy in Europe

I Cerecedo,1* J Zamora,2* M Fox,3 J Voordouw,4 N Plana,5 E Rokicka,6 M Fernandez-Rivas,7 S Vázquez Cortés,7 M Reche,8 A Fiandor,8 M Kowalski,9 G Antonides,10 M Mugford,11 LJ Frewer,4 B de la Hoz1
1Servicio de Alergología, Hospital Universitario Ramón y Cajal, Madrid, Spain
2Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
3University of East Anglia, Health Economics Group, School of Medicine, Health Policy and Practice, Norwich, UK
4Wageningen University, Marketing and Consumer Behaviour Group, Wageningen, The Netherlands
5CIBER de Epidemiología y Salud Pública (CIBERESP), Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain
6University of Lodz, Institute of Sociology, Lodz, Poland
7Servicio de Alergología, Hospital Universitario Clínico San Carlos, Madrid, Spain
8Servicio de Alergología, Hospital Universitario La Paz, Madrid, Spain
9Lodz University, Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Lodz, Poland
10Wageningen University, Economics of Consumers and Households group, Wageningen, The Netherlands
11University of East Anglia, Health Economics Group, School of Medicine, Health Policy and Practice, Norwich, UK
*These authors contributed equally to this study
 
 Abstract

Background: Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias.
Objective: To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy.
Methods: A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year.
Results: Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group’s spending decreased by a median of $87.3 (P=.031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P=.040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3).
Conclusion: DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food.

Key words: Food allergy. Double-Blind Placebo-Controlled Food Challenge. Diagnosis. Socioeconomic impact.
 

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