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Evaluating the Cost and Utility of Mandating Schools to Stock Epinephrine Auto-injectors

机译：评估授权学校股票肾上腺素自动注射器的成本和效用

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Background: The Michigan Legislature mandated that all public schools stock epinephrine auto-injectors (EAIs). A minimal amount is known regarding the incremental value of EAIs in schools. Our primary objective was to describe the frequency of administration of epinephrine for EMS patients with acute allergic reactions in public schools. Our secondary objective was to estimate the cost of mandating public schools to stock EAIs. Methods: We performed a retrospective cohort study of EMS cases with an impression of allergic reaction and who received epinephrine recorded in the 2014 Michigan EMS Information System (MI-EMSIS). We abstracted patient demographics, incident location by address to identify public schools, source of epinephrine given, and suspected allergen if known. We calculated advanced life support (ALS) response times to assess temporal impact of school EAIs in communities with ALS systems. We estimated the unsubsidized annual procurement cost of this mandate for Michigan public schools (N = 4,039), using range of costs for the required 2 EAIs (adult and pediatric) as estimated by the legislature ($140/each) and recently reported costs for commercial sources ($1,200). Training costs were not included. Descriptive statistics are reported. Results: During this period, there were 1,550,009 EMS cases in the state with 631 receiving non-cardiac arrest epinephrine for presumed anaphylaxis, of which 23 cases were in public schools. Reported allergens were most often food 12 (51.2%), insect stings 4(22.2%) or unknown 7(30.4%). Among these patients, the source for epinephrine used was from the student, 7 (30.4%), EMS 7 (30.4%), school 7(30.4%), and unknown 2(8.7%). A majority (21, 91.3%) of the public school cases occurred in communities with ALS systems and ALS response was relatively rapid (median response 6 minutes, 90 percentile, 13 minutes). The unsubsidized annual cost of Michigan public schools to stock EAIs ranges from $565,460 to $4,846,800. Conclusion: In this study, few public school patients received epinephrine for anaphylaxis and the vast majority occurred in communities with rapid ALS response. The direct annual supply cost of the school EAI mandate is substantial.
机译：背景：密歇根立法机构强调，所有公立学校股票肾上腺素自动注射器（EAIS）。关于学校EAI的增量值，已知一种最小的量。我们的主要目标是描述公立学校急性过敏反应的EMS患者肾上腺素施用频率。我们的二级目标是估计授权公立学校股票Eeis的成本。方法：我们对EMS病例进行了回顾性队列研究，具有过敏反应的印象，以及在2014年密歇根EMS信息系统（MI-EMSIS）中获得的肾上腺素。我们抽象了患者人口统计，通过地址，识别公立学校，给予的肾上腺素来源，如果已知，则怀疑过敏原。我们计算了先进的生活支持（ALS）响应时间，以评估学校EAI与ALS系统社区的时间影响。我们估计，为密歇根州公立学校（n = 4,039），使用所需的2个EAIS（成人和儿科）的成本范围，估计该任务的未补偿年度采购成本，该等地区（成人和儿科）估计（140美元/每人），最近报告了商业成本来源（1,200美元）。不包括培训费用。报告了描述性统计数据。结果：在此期间，患有1,550,009个EMS病例，其中631例接受非心脏捕捞肾上腺素的假定过敏，其中23例在公立学校。报告的过敏原是食物12（51.2％），昆虫蜇4（22.2％）或未知7（30.4％）。在这些患者中，使用的肾上腺素来源来自学生，7（30.4％），EMS 7（30.4％），学校7（30.4％）和未知2（8.7％）。在与ALS系统和ALS反应的社区中发生的大多数（21,3.3％）的公共学院案件相对较快（中位数响应6分钟，90百分位数，13分钟）。未订制的密歇根州公立学校的年度成本从565,460美元到4,846,800美元。结论：在本研究中，很少有公共学校患者接受过肾上腺素的肾上腺素，并且绝大多数都发生在迅速ALS反应的社区。学校EAI授权的直接年度供应成本是很大的。

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