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ANAHEIM, Calif. -- The economic cost of food allergy in an average American child tops $4,000, with less than 20% of that attributable to direct medical expenses, a researcher said here.

More than half the cost is in the form of career sacrifices by parents of food-allergic children, said Ruchi Gupta, MD, MPH, of Northwestern University in Chicago, who led a survey of 1,643 parents with food-allergic children.

Respondents estimated that having to change or leave jobs, take part-time work, or otherwise give up income in order to care properly for a food-allergic child had cost them an average of $2,399 annually, Gupta told attendees at the American College of Allergy, Asthma, and Immunology annual meeting.

More than $1,700 of that total came from respondents who said they had to quit jobs or had been fired in connection with a child's food allergy.

Extrapolated to the entire U.S., she and colleagues estimated the total economic burden of children's food allergies at about $25 billion annually.

She added that this cost might be cut substantially by "provid[ing] safe environments for children with food allergies," which in turn would give parents more career freedom.

Gupta and colleagues were responsible for an earlier survey, released last year, that found the U.S. prevalence of food allergy in children and teens had reached 8% -- vastly higher than many previous estimates.

In the current work, she and colleagues contacted parents of food-allergic children last winter and asked them a series of questions about their direct and indirect costs associated with caring for the child.

The questions were in four categories: direct medical costs associated with physician office visits, hospitalizations, and emergency room visits covered by insurance; out of pocket costs for drugs and special foods, travel for the child's healthcare, and other expenses paid by parents; lost worktime for taking children for clinic and hospital visits; and sacrificed employment opportunities such as having to quit a job, work part-time, or change jobs in order to accommodate the allergic child's care.

Respondents provided their own estimates of the dollar costs in each category, except for direct medical expenses. For the latter, Gupta and colleagues asked for numbers of hospitalizations and emergency room visits in the past year, and then calculated the dollar cost from Medicare reimbursement levels. As such, she said, those costs are likely to be underestimates because Medicaid usually pays less than private insurance.

The top 1% of parents' dollar estimates of out-of-pocket costs and forgone career opportunities were dropped from the analysis.

Children of respondents ranged from infants to 17-years-old and were evenly divided by gender. Some 41% of the children were described by parents as having had severe reactions at some point. The allergic foods included peanuts, milk, shellfish, tree nuts, and eggs.

The yearly economic burdens associated with each of the four major categories per food-allergic child and nationally were as follows:

• Direct medical costs: $724 per child, $4.3 billion nationally
• Out-of-pocket costs: $931 per child, $5.5 billion nationally
• Lost work productivity: $130 per child, $0.8 billion nationally
• Forgone work opportunities: $2,399 per child, $14.2 billion nationally

The per-child total summed to $4,184 (95% CI $3,475 to $4,960), Gupta said, with a national annual burden of $24.8 billion. The parental share, excluding the direct medical costs covered by third-party payers, was $3,457 annually.

Interestingly, Gupta said, respondents were also asked in the survey how much they would be willing to spend to cure their child of food allergy.

The average response, after throwing out answers exceeding $10,000 monthly, was $3,504 (95% CI $2,652 to $4,344), which was virtually identical to the estimate of actual average costs borne by parents. Gupta suggested that this was an independent corroboration of the investigators' estimates.

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