659 - Understanding Barriers to Obtaining Epinephrine Auto-Injectors

Publication Number: 659.6738

Hunter G. Smith, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jennifer Saper, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Approximately 8% of children in the U.S. have a food allergy with peanuts being the most prevalent allergy, affecting 2.2% of children. Given a high prevalence of children with food allergies, healthcare utilization related to food allergies also increases, including ED visits, anaphylactic reactions, epinephrine autoinjector prescriptions, and hospitalizations.

Objective: We hypothesize that caregivers of pediatric patients with food allergies causing anaphylaxis whose primary care provider or allergist can adequately answer questions regarding their allergy and appropriate epinephrine autoinjectors use are more likely to believe epinephrine autoinjectors should always be with their child. We also theorize that barriers to obtaining epinephrine autoinjectors are equally prevalent in publicly and privately insure patients and more prevalent in those without regular allergists visits.

Design/Methods: A parent/caregiver-report survey to assess current attitudes about and access to epinephrine autoinjectors was administered in English and Spanish through Qualtrics between March and April 2024 to a Chicago sample of 3,337 parents/caregivers with 440 parents/caregivers completing the survey. Patients were included if they had an ICD 10 diagnosis of anaphylaxis due to food allergy. Any patient with anaphylaxis not related to food allergies was excluded.

The study was reviewed by the Ann and Robert H. Lurie Children’s Hospital of Chicago Institutional Review Board and approved as exempt. Chi-square statistics were utilized to draw conclusions between patient demographics and epinephrine autoinjector costs and barriers.

Results: Of those completing the survey, 84.7% were commercially insured and 96.5% saw an allergist. Caregivers reported a broad distribution of out-of-pocket cost for epinephrine autoinjectors ranging from $0-5 to over $400 with 64% paying less than $100 out-of-pocket. Publicly insured patients were more likely to pay less than $50 for their epinephrine autoinjector than their privately insured counterparts (88% compared to 43%, p< 0.001).

Respondents that agreed or strongly agreed that their primary care provider could adequately answer questions regarding their child’s food allergy were more likely to carry their epinephrine autoinjector with them in all locations.

Conclusion(s): Findings suggest that caregivers with knowledgeable primary care providers and allergists are more likely to have children with epinephrine autoinjectors in all settings. The primary barriers to epinephrine autoinjectors include cost, insurance, and expiration dates.