Epinephrine autoinjectors are expensive, allergists suggest low-cost alternative: a prefilled syringe

The wholesale price of 1 epinephrine autoinjector increased annually from $35.59 in 1986 to $87.92 in 2011 (147%). Among patients prescribed autoinjectors, only 40% of teens/adults and 60% of children less than 12 years of age had them refilled over a 6-year period. The retail price of the new "EpiPen 2-pak" that the patients often quote is more than $250 for each "pak". In August 2012, the FDA approved Auvi-Q - the first-and-only epinephrine autoinjector with audio and visual cues that guide patients and caregivers step-by-step through the injection process. No information about the price of Auvi-Q is available at this time but it is not expected to cost significantly less than EpiPen.

There are lower-cost alternatives to epinephrine autoinjectors. Recently, three allergists from the University of South Florida suggested in JACI thar prefilled epinephrine syringes made in a clinic can be safely provided to patients who cannot afford prescription autoinjectors.

Prefilled syringes are stable and sterile for 2 months in dry climates and 3 months in humid climates.

Materials needed to prepare a prefilled syringe are simple:

1. ampule containing 1 mg/mL epinephrine plus a preservative
2. disposable plastic 1-mL syringe
3. 23-gauge, 2.5-cm needle

Parents take 140 seconds to withdraw epinephrine from an ampule into a syringe, therefore a prefilled syringe is recommended.

Epinephrine is light sensitive, and the ampule and prefilled syringes should be protected from light by:

- wrapping them in aluminum foil
- keeping them in a light-free container, such as an eyeglasses case

This 2-minute video shows the Sanofi's new voice guided Auvi-Q epinephrine injector in action:



References:

Increasing cost of epinephrine autoinjectors. The Journal of Allergy and Clinical Immunology
Volume 130, Issue 3 , Pages 822-823, September 2012.

Image source: OpenClipArt.org, public domain.

Comments from Twitter:

Allergic Living @AllergicLiving: Would anyone prescribe epi syringe? + short shelf life. Should allergists press for a 1-pak too, as 1 better than 0? #foodallergy

‏@Allergy: As you know, EpiPen Single Packages were Discontinued 1 year ago. Only "2-paks" are available now: http://bit.ly/P7J0Ch

Allergic Living @AllergicLiving: That's my point, should they be "encouraged' to return as an additional option, perhaps by AAAAI?

Craig, CEN, CCRN @CraigCCRNCEN: My ANA kit with Benadryl also is cheaper and less painful to administer.

Tiffany @iknowtiffany: Yah, right. That's *perfect* for schools, parents in midst of crisis, carrying around at all times. #not