Economic modelling of providing “spare” adrenaline autoinjectors to all schools to improve the management of anaphylaxis

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ABSTRACT Objective To analyse NHS health datasets to estimate the cost of providing emergency adrenaline 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 in 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 i) Proportion of school children with food allergy prescribed AAI; ii) Cost of providing more than 2 AAIs to individual pupils mapped to Integrated care boards (ICBs) in England, compared to the cost of providing 4 “spare” AAIs to every school, for the academic year 2023/24. Results 44% of school-aged children in CRPD 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 2 AAIs, at an estimated cost of over £9million. The estimated cost of providing “spare” AAIs to every school was £4.5million. Were “spare” AAIs to replace the supply of named-patient AAIs exclusively to leave on school premises, this would represent a potential cost-saving of at least £4.6million 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. KEY MESSAGES What is already known on this topic In 2017, UK legislation was changed to allow schools to obtain, without prescription, “spare” adrenaline autoinjector (AAI) devices for the emergency treatment of anaphylaxis in any school pupil. What this study adds Under half of school-aged children with food allergy (and at potential risk of anaphylaxis) are prescribed AAIs. While the MHRA recommends people at risk of anaphylaxis carry 2 AAIs, in school-children prescribed AAIs, over 60% were dispensed more than 4 AAIs in the academic year 2023/24; it is likely that the majority of these additional AAIs were for provided to be left on school premises. If “spare” AAIs were provided to all schools, to avoid the need for pupils to leave their own AAIs on school premises, this would represent a potential cost-saving of at least £4.6million or 25% of the total national expenditure for AAIs. How this study might affect research, practice or policy This analysis clearly demonstrates providing “spare” AAIs to schools (at no cost to the school) would be a cost-neutral strategy which would improve emergency access to AAIs for all school pupils (not just the minority prescribed AAIs) and also increase the resilience of the UK supply chain for AAIs.

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