Health-care cost reduction resulting from primary-care allergy testing in children in Italy

The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care.The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%.spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.Over the past 40 years, the prevalence of atopic disease has increased, particularly in Western, industrialised countries; most of the allergy-related morbidity associated with the respiratory system is accounted for by asthma and allergic rhinitis [1]. Importantly, these conditions substantially affect patients' quality of life [2-4] placing a large burden on society in terms of both direct medical expenditure and decreased productivity [5,6]. In the U.S., the estimated annual cost for asthma is US$14 billion in direct and indirect costs [7]. The total per-person annual costs of asthma in this country average $4912.00, with direct and indirect costs accounting for $3180 (65%) and $1732 (35%), respectively. The largest components within direct costs are pharmaceuticals [$1605 (50%)], hospital admissions [$463 (15%)] and non-emergency department ambulatory visits [$342 (11%)] [8]. Such burden, reduced by an appropriate diagnostic and screening process for allergy aimed to increase the appropriateness of referrals from primary care to the specialist level[9,10], is paid for at the social level either directly