{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:56:36Z","timestamp":1771923396628,"version":"3.50.1"},"reference-count":53,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Anaphylaxis is life-threatening and requires immediate treatment with injectable epinephrine. Among the 20 million children attending US summer camps yearly, 2.5% (approximately\u2009500\u2009000) have immunoglobulin E (IgE)\u2013mediated food allergies and fewer than half bring their epinephrine to camp.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>We aimed to investigate the cost-effectiveness of stock epinephrine in US summer camps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Using a decision-analytic Markov model, the outcomes of pediatric anaphylaxis were simulated using 4 strategies: (1) individual-provided epinephrine, (2) stock epinephrine, (3) current practice, and (4) stock epinephrine\u2009plus\u2009individual epinephrine. Secondary analyses included cost per hospitalization avoided and cost-effectiveness of nurse-drawn epinephrine solution and, in a 3-year model, intranasal epinephrine instead of autoinjectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Stock epinephrine was the least expensive and most effective ($4.33, 69.9 quality-adjusted life-days [QALDs]) strategy. The model was sensitive to the quantity of campers with IgE-mediated food allergy. In camps in which stock epinephrine was infeasible, individual-provided epinephrine was preferred. In 1-way sensitivity analyses, results were sensitive to epinephrine cost, IgE-mediated food allergy and anaphylaxis risks, hospitalization risk, and the number of weekly campers. Secondary analyses demonstrated that the individual-provided epinephrine strategy resulted in the most hospitalizations; stock epinephrine\u2009plus\u2009individual epinephrine cost $9476 per hospitalization avoided. Stock epinephrine\u2009plus\u2009individual epinephrine was the preferred strategy for nurse-drawn epinephrine solution ($8.72, 69.9 QALDs) and intranasal epinephrine ($27.07, 209.9 QALDs, 3 camp seasons).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>A strategy of stock epinephrine autoinjectors alone was the most cost-effective in our model. A strategy of stock epinephrine\u2009plus\u2009individual epinephrine became more economically feasible when epinephrine costs were lower or IgE-mediated food allergy risk was higher.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2024-068960","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T11:56:39Z","timestamp":1746100599000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness Analysis of Undesignated Stock Epinephrine for Anaphylaxis in US Summer Camps"],"prefix":"10.1542","volume":"155","author":[{"given":"Carissa","family":"Bunke","sequence":"first","affiliation":[{"name":"1Children\u2019s Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Schellpfeffer","sequence":"additional","affiliation":[{"name":"2University of Michigan, Ann Arbor, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvey","family":"Leo","sequence":"additional","affiliation":[{"name":"3Allergy and Immunology Associates of Michigan, Ann Arbor, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hashikawa","sequence":"additional","affiliation":[{"name":"2University of Michigan, Ann Arbor, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J.","family":"Smith","sequence":"additional","affiliation":[{"name":"4University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry","family":"Garst","sequence":"additional","affiliation":[{"name":"5Clemson University, Clemson, South Carolina"},{"name":"6Alliance for Camp Health, Fishersville, Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Gaslin","sequence":"additional","affiliation":[{"name":"6Alliance for Camp Health, Fishersville, Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen A.","family":"Noorbakhsh","sequence":"additional","affiliation":[{"name":"7Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"issue":"10","key":"2026022402525440800_r1","first-page":"1","article-title":"Food allergy among U.S. children: trends in prevalence and hospitalizations","author":"Branum","year":"2008","journal-title":"NCHS Data Brief."},{"issue":"6","key":"2026022402525440800_r2","doi-asserted-by":"crossref","first-page":"e20181235","DOI":"10.1542\/peds.2018-1235","article-title":"The public health impact of parent-reported 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