Funding of Epipens auto injectors for emergency treatment of anaphylaxis in NZ

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In 2011 the World Allergy Organisation published the first global guidelines for the assessment and management of anaphylaxis. Anaphylaxis is a serious allergic reaction characterised by rapid onset and it is life threatening.

It is commonly accepted the rate of occurence of anaphylaxis in the general population is underestimated because of under recognition by patients, caregivers and misdiagnosis by health care professionals.

Equally, anaphylaxis fatalities are often not diagnosed because of absence of historical details from eyewitnesses, incomplete death scene investigations, paucity of specific pathologic finding at postmortem examination and lack of disease specific laboratory tests.

Globally, the incidence of allergic disease has increased over the past 10 years and so has the incidence of anaphylaxis. The World Health Organisation has classified epinephrine (adrenaline) as the first line treatment for anaphylaxis and the literature available consistently emphasises the importance of timely administration of epinephrine (within the first 5 minutes of symptoms occuring).

The literature also identifies the lack of access to epinephrine or incorrect administration of epinephrine as significant factors where anaphylaxis has resulted in fatality. The evidence base for prompt epinephrine injection in the initial phase of anaphylaxis is stronger than the evidence base for the use of antihistamines.

Epinephrine should be injected by the intramuscular route in the mid anterolaterial thigh as soon as anaphylaxis is suspected in a dose of 0.01mg/kg of a 1:1,000 solution to a maximum of 0.5mg in adults (0.3 mg in children).  The dose may need to be repeated every 5 - 15 minutes as needed. It is not unusual for more than 2 doses to be required.

Australia and New Zealand have among the highest prevalence of allergic disorders in the world. Estimates of anaphylaxis incidence vary widely from 1 episode per 31,000 people per year up to 1 in 1700 people per year. Studies have consistently highlighted the under reporting and inadequate recording of incidence. The emphasis on mortality figures and rates has tended to detract from chronic morbidity experienced by patients and their carers on a daily basis.

Historically, anaphylaxis has been associated with hospital settings and allergic reaction to medical treatment but this pattern has shifted with a greater number of incidents occuring in the community setting. In response to these developments other jurisdictions have made provision to ensure individuals, families and schools have access to epinephrine in an emergency.

Given the need to administer epinephrine rapidly and accurately it is widely accepted as best practice for epinephrine auto-injectors to be available for community use. The World Allergy Organisation emphasises the importance of availability and accessibility of epinephrine in the treatment of anaphylactic emergency in a recent consensus statement.

Year after year Allergy New Zealand has made applications to Pharmacy in New Zealand with a view to securing funding to help subsidise the cost of epinephrine auto-injectors in the community. Currently, in New Zealand, pharmacies are charging around $140 for an epinephrine autoinjector. Patients require at least two of these and they need replacing every year. Many families are struggling to afford these additional costs on top of the additional costs associated with living with severe allergic disease.

In the UK, the prescription of two epinephrine auto-injectors is fully funded and this is the case in Australia. In New Zealand Pharmacy have consistently declined to consider subsidisation of epinephrine auto-injectors. New Zealand is failing individuals and families coping with allergic disease in many areas with inadequate specialist service provision. The funding of epinephrine auto-injectors would go some way to bringing New Zealand in line with best practices being adopted by the majority of other countries in the OECD.

We the undersigned respectfully request you undertake further review of this matter.

Resources -

Online support for individuals and families living with allergies - check out Allergy Support New Zealand: https://www.facebook.com/groups/allergysupportnz/

www.allergy.org.au 

www.allergy.org.nz

www.aaaai.org

www.worldallergy.org

www.ncbi.nlm.nih.gov

 

 



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