Costs and uptake of a community model of paediatric food allergy care versus specialist hospital care: A before-and-after controlled trial

Aim To compare the costs of community‐based food allergy model of care (intervention cohort, IC) with a tertiary‐hospital, specialist allergy clinic model of care (control cohort, CC). Methods In this pragmatic controlled trial, children (aged 0–12 years) newly referred to the allergy clinic at Melbourne's Royal Children's Hospital with suspected/known food allergy to three or fewer foods were allocated to see either a community‐based paediatrician, trained via online webinars and web‐based clinical decision support tools for food allergy diagnosis and management, or a hospital allergist. Per‐patient costs to the health‐care system and out‐of‐pocket costs to families seen within 12 months (clinician time, allergy tests and medicare billing) were compared between the two models of care. Results At 12 months, 54/181 (30%) CC families had been seen in the allergy clinic and 93/115 (81%) of the IC families who chose to see a community paediatrician had been seen. In an intention‐to‐treat analysis (ITT), health‐care system costs per IC patient were higher than the costs per CC patient (mean cost $333 versus $319, respectively; mean difference $14, 95% Confidence Interval (CI) −97 to 118, P = 0.81). Total out‐of‐pocket costs to family were $129 in the IC compared with $89 in the CC (mean difference $40, 95% CI $4–$77, P = 0.03). Conclusions A community‐based model of care for simple food allergy showed that costs to the health‐care system were similar between the community model and hospital care but did not show reduced out‐of‐pocket costs to the families 12‐months post‐enrolment