American Academy of Allergy, Asthma & Immunology Annual Meeting

American Academy of Allergy, Asthma & Immunology Annual Meeting

March 06, 2017
2 min read

Online epinephrine autoinjector costs vary significantly

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ATLANTA — Significant online cost differences among epinephrine autoinjector devices do not correspond with incremental benefit, according to findings presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

“Peanut allergy affects 2% of children under 18 years of age, or 1.5 million children,” Marcus S. Shaker, MD, MS, FAAAAI, coauthor of the study and associate professor of pediatrics at the Geisel School of Medicine at Dartmouth College, told Healio Internal Medicine. “Because peanut allergen is difficult to avoid, approximately 12% of peanut allergic children experience repeated allergic reactions each year and most of these reactions are potentially life threatening.”

Marcus S. Shaker

“Rapid access to epinephrine can be a life-saving intervention for those suffering from food allergy leading to anaphylaxis,” he added. “The recent controversy of the unjustified 400% Epipen cost increase has been met with frustration on the part of patients and providers. In 2016, three commercial epinephrine autoinjectors were available in the United States: Epipen, Adrenaclick and Epinephrine injection, USP autoinjector.”

Shaker and colleague Katherine Bean, also of Geisel School of Medicine, investigated the variation in corporate and independent pharmacies’ costs for epinephrine autoinjector devices in New England, and assessed the “wasted expense” associated with incremental autoinjector costs. They determined costs of living with food allergy using TreeAge Pro, decision analysis software, and used a comparative prescription drug pricing service ( to integrate costs of Epipen or Epinephrine injection, USP autoinjector into Markov microsimulations for children with peanut allergy over a 20-year period. Costs analyzed included provider visits, ambulance transports, emergency care, hospitalizations, grocery costs and job-related opportunity costs.

The researchers found that the lowest costs for double packs of Epipen and Epinephrine injection, USP autoinjector were $616 and $144.62, respectively. When assuming an annual prescription of two double packs, they determined that the mean cost of living with peanut allergy totaled $58,667 for those prescribed Epipen and $45,588 for those prescribed Epinephrine injection, USP autoinjector. There were no differences in effectiveness between groups, each accumulating 17.19 quality adjusted life years. A total of 2.03 allergic reactions and 1.04 episodes of anaphylaxis were experienced by participants in each simulation. Over the model horizon, there were $12,576 in incremental costs per episode of anaphylaxis for those using Epipen, potentially rising to $18,728 if three double packs were prescribed each year.

“There was a greater than 3.5 times cost variation in the cost of epinephrine autoinjectors available in New England compared with online availability,” Shaker said. “Prices of devices range from $155 to $698 per double pack. While there is little cost variation by New England state, online and Canadian costs are much lower.”

“These data support ongoing patient and family education regarding options for epinephrine autoinjector preparedness,” he concluded. – by Alaina Tedesco


Bean K, Shaker MS. Abstract 282. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta.

Disclosure: The researchers report no relevant financial disclosures.