Economic modelling of providing 'spare' adrenaline autoinjectors to all schools to improve the management of anaphylaxis.

OBJECTIVE

To analyse NHS health datasets to estimate the cost of providing emergency adrenaline [epinephrine] autoinjectors (AAIs) to school pupils on a named-patient basis to leave on school premises versus providing 'spare' AAIs to schools which can be used for any school pupil.

DESIGN

Retrospective cohort study.

SETTING

English primary electronic health data from the Clinical Practice Research Datalink (CPRD) and English prescriptions data from the NHS Business Services Authority.

PARTICIPANTS

School-aged children in England.

MAIN OUTCOME MEASURES: (1) Proportion of school children with food allergy prescribed AAI; (2) cost of providing more than two AAIs to individual pupils mapped to integrated care boards (ICBs) in England compared with the cost of providing four spare AAIs to every school for the academic year 2023/24.

RESULTS

44% of school-aged children in the CPRD had at least one AAI prescription and only 34% had repeat AAIs prescribed. In pupils with previous anaphylaxis, rates were 59% and 44%, respectively. During the academic year 2023/24, 63% of pupils were dispensed more than two AAIs at an estimated cost of over £9 million. The estimated cost of providing spare AAIs to every school was £4.5 million. If spare AAIs were to replace the supply of named-patient AAIs exclusively to leave on school premises, this would represent a potential cost-saving of at least £4.6 million or 25% of the total national expenditure for AAIs.

CONCLUSIONS

Under half of children at risk of anaphylaxis are prescribed AAIs. Providing spare AAIs to all schools (at no cost to the school) would be a cost-neutral strategy for the vast majority of ICBs and one that is likely to improve emergency access to AAIs and therefore safety.