The ability to avoid routine needle carrying skyrocketed the value-based price (VBP) of nasal epinephrine to more than 1200% above baseline, according to new modeling data presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

“Needle-phobia poses challenges for promptly treating anaphylaxis,” wrote Niraj Patel, MD, an associate professor of pediatrics at Duke University School of Medicine, Durham, North Carolina, and colleagues. Despite the need for needle-free alternatives, the value of such treatments, and their cost-effectiveness, has not been well studied, the researchers said.

The researchers created a cost-effectiveness model to compare the VBP of treating anaphylaxis with nasal epinephrine vs an intramuscular auto-injector. VBP was defined as the maximal price based on societal value at a willingness-to-pay threshold of $150,000.

The model estimated quality-of-life (QOL) impacts for three scenarios. The baseline scenario of no reduction in QOL associated with needle use was estimated at $450. The second scenario, a needle-related QOL decrease per severe reaction, increased the value of the VBP of nasal epinephrine by 26%. In a third scenario, the decrease in QOL related to daily needle carrying increased the VBP of nasal epinephrine by 734% to 1288% above baseline.

The model included not only medical costs, such as primary care and specialist visits, severe reaction costs, and treatment costs, but also nonmedical costs related to diet changes and productivity. The model also factored in sensitivity analyses for shelf-life and needle aversion impacts.

The findings were limited by several factors including the use of a model, but the results suggest that needle-free epinephrine conveys a significan value on QOL apart from its shelf life and clinical efficacy, the researchers concluded.

Model Data Encouraging, Real-World Studies Needed

Evaluating the effectiveness and cost-effectiveness of a needle-free epinephrine option is important because these aspects remain underexplored, said Arianne K. Baldomero, MD, pulmonologist and assistant professor of medicine at the University of Minnesota, Minneapolis, who was not involved in the study.

“Individuals with allergic reactions or anaphylaxis may avoid using injectable epinephrine because needle aversion or phobia,” Baldomero told Medscape Medical News.

The nasal epinephrine spray is relatively new; therefore, its real-world effectiveness remains uncertain, said Baldomero, who was not aware of any patients in her practice who had used the spray to date. Potential barriers to the effectiveness of the spray in practice include nasal congestion in patients, which may reduce drug absorption, Baldomero noted. More research is needed to explore how nasal congestion and other similar conditions might affect delivery and efficacy of the spray, she added.

Other areas in need of additional research include safety profiles of potential side effects, such as headache or local irritation, and patient-outcome studies to further evaluate real-world effectiveness, Baldomero said.

The study supported in part by ARS Pharmaceuticals. The researchers had no financial conflicts to disclose. Baldomero had no financial conflicts to disclose.