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

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 GBP9million. The estimated cost of providing 'spare' AAIs to every school was GBP4.5million. 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 GBP4.6million 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.