Both PPOIT and OIT were cost-effective and good value compared with no treatment for peanut allergy in children, with OIT associated with a larger effect size for remission but no clinically meaningful difference, and PPOIT offering the best value when QALYs are prioritized.
Key Findings
Results
Mean costs per patient over a 10-year horizon were highest for PPOIT, followed by OIT, and lowest for no treatment.
Mean (SD) cost per patient was A$3956 (A$67) for PPOIT, A$3582 (A$57) for OIT, and A$249 (A$87) for no treatment.
For PPOIT, treatment costs were A$3579 and adverse event costs were A$377.
For OIT, treatment costs were A$3179 and adverse event costs were A$402.
For no treatment, all costs (A$249) were attributable to adverse events.
Costs were evaluated from a health care payer perspective and calculated in Australian dollars.
Results
Mean annual remission rates were substantially higher for both OIT and PPOIT compared with no treatment.
Mean (SD) annual remission was 34.1% (12.7%) for PPOIT, 35.1% (15.4%) for OIT, and 7.3% (8.1%) for no treatment.
OIT was associated with a slightly higher remission rate than PPOIT, but no clinically meaningful difference was observed.
The study included 201 children aged 1 to 10 years (mean [SD] age, 5.9 [2.8] years; 129 [64.2%] male).
The time horizon was 10 years, including 1.5 years of active treatment, 2 years of posttreatment follow-up, and 6.5 years of extrapolation.
Results
Total QALYs gained over the 10-year horizon were higher for PPOIT than OIT, with no treatment serving as the reference.
Total QALYs gained were 0.096 for PPOIT, 0.055 for OIT, and 0 for no treatment.
PPOIT achieved better quality-of-life outcomes despite being only slightly more costly than OIT.
Effectiveness was measured using both remission achieved and patient quality-adjusted life years (QALYs) gained.
Results
Both PPOIT and OIT were cost-effective compared with no treatment when measured by cost per year of remission achieved.
Cost per year of remission achieved was A$1384 (95% CI, A$1269–A$1415) for PPOIT and A$1199 (95% CI, A$1091–A$1217) for OIT.
OIT had a lower incremental cost per year of remission than PPOIT.
Both treatments were described as cost-effective and good value compared with no treatment.
Results
When QALYs are the primary outcome, PPOIT was more cost-effective than OIT compared with no treatment.
Incremental cost per QALY gained was A$38,435 (95% CI, A$31,058–A$48,668) for PPOIT and A$60,840 (95% CI, A$49,479–A$86,531) for OIT.
PPOIT's cost per QALY was approximately 37% lower than OIT's cost per QALY.
The authors concluded that 'when QALYs are prioritized, PPOIT offers the best value.'
Discussion
Key factors associated with cost-effectiveness of peanut OIT treatments were treatment product pricing and patient quality of life.
Sensitivity analyses were conducted to capture uncertainty in the model.
The study was conducted alongside a multicenter, randomized, placebo-controlled clinical trial in Australia between 2016 and 2019.
Data were analyzed from May 2024 to August 2025.
The authors identified treatment product pricing and patient quality of life as the key drivers of cost-effectiveness results.
Methods
The trial enrolled 201 children aged 1 to 10 years allocated across three groups: PPOIT, OIT, and no treatment.
79 children were in the PPOIT group, 83 in the OIT group, and 39 in the no treatment group.
Mean (SD) age was 5.9 (2.8) years; 129 (64.2%) were male.
The study was a multicenter, randomized, placebo-controlled clinical trial conducted in Australia.
PPOIT is a variant of OIT that incorporates probiotics alongside peanut oral immunotherapy.
Huang L, Lloyd M, Franz A, Loke P, O'Sullivan M, Gold M, et al.. (2026). Cost-Effectiveness of Oral Immunotherapy Treatments vs No Treatment for Peanut Allergy in Children.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.2410