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The health and economic outcomes of early egg introduction strategies

机译：早期蛋介绍策略的健康和经济结果

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Abstract Background Studies suggest early egg introduction ( EEI ) in the first year of life is associated with reduced risk of developing egg allergy. No US recommendations exist regarding optimally implementing EEI . Methods Using simulation and Markov modelling over a 20‐year horizon, we explored optimal EEI strategies applied to US , European and Canadian populations, comparing screening of high‐risk infants (skin prick testing [SPT] or serum‐specific IgE[ sIgE ]) before introducing cooked egg at 6?months of life vs egg introduction at home, without screening, for all infants. Results A no‐screen approach dominated egg SPT screening of high‐risk infants with early‐onset eczema. Base model per‐patient incremental costs of SPT were $6865 US dollars ( USD ), 6801 euros and $10?610 Canadian dollars ( CAD ). For egg sIgE screening in primary care settings, base model incremental costs were $16?722 USD , 18?072 euros and $28?193 CAD . As the simulation concluded 2.5% were egg allergic without screening vs 9.5%, 12% and 21.4% of children undergoing SPT , delayed introduction or sIgE screening. Incremental societal costs from screening reached $2?009?351?175 USD for SPT and $4?894?445?790 USD for sIgE testing. In sensitivity analyses, if the risk of reaction with initial egg ingestion was ≥22.5%, SPT before EEI became a preferred strategy. A no‐screen approach dominated both EEI of raw pasteurized egg and delayed cooked egg introduction approaches. Conclusions Assuming initial reaction rates??22.5%, a no‐screening EEI cooked egg approach has superior health and economic benefits in terms of number of egg allergy cases prevented and total healthcare costs vs screening testing.
机译：摘要背景研究表明早期蛋介绍（EEI）在生命的第一年与降低蛋过热风险的风险有关。没有关于最佳实施EEI的建议。方法采用模拟和马尔可夫建模在20年代的地平线上，我们探讨了适用于美国，欧洲和加拿大人口的最佳EEI策略，比较高危婴儿的筛查（皮肤刺鼠[SPT]或血清特异性IgE [Sige]）在将煮熟的鸡蛋引入6？几个月的生活中，在家里的蛋介绍，没有筛选，对所有婴儿。结果禁止缺口方法用早起的湿疹占高风险婴儿的卵子SPT筛选。 SPT的基础型号为每患者的增量成本为6865美元（USD），6801欧元和10美元？加拿大510美元（CAD）。对于初级保健设置中的鸡蛋SiGe筛选，基础模型增量成本为16美元？722 USD，18？072欧元和28美元？193 CAD。由于模拟结束了2.5％的是鸡蛋过敏而没有筛选的9.5％，12％和21.4％正在进行SPT，延迟引入或SiGe筛选。从筛选中增加的社会成本达到2美元？009？351？351？175 USD为SPT和4美元？894？445？790 USD用于SiGe测试。在敏感性分析中，如果与初始卵泡的反应的风险≥22.5％，则EEI之前的SPT成为优选的策略。禁止屏幕方法主导了原始巴氏杀菌鸡蛋的EEI和延迟煮熟的蛋介绍方法。结论假设初始反应速率Δδ，含有无筛选的EEI煮熟的鸡蛋方法在鸡蛋过敏病例的数量方面具有卓越的健康和经济效益，并进行了总医疗费用对筛查测试。

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