What is the cost of desensitisation to peanut with PALFORZIA?

Peanut OIT can appear expensive because of the different components involved in delivering the overall package of care. Our ethos has been to focus on the safest possible environment for the dose escalation visits as well as highly experienced medical staff, all of whom have a long-standing track record of excellent care in food immunotherapy through both research and clinical practice.

Before entry to the treatment, an assessment visit is required. This will be offered following the completion of a suitability questionnaire and we will aim to avoid assessment visits if it is clear from the questionnaire that a child is not suitable. An assessment visit is required even if you are a well-known patient of one of our Professors. This is because we will still need to sign a formal consent form, for which we need to ensure you and your child have a full understanding of what is involved and the possible risks. The details of this are as follows:

• For patients who have been seen by a member of our consultant team in the previous 12 months, this assessment appointment will be charged at £300 (including the cost of a skin prick test to peanut), which is non-refundable regardless of the final decision whether to progress to the treatment or not. If further testing is required, such as lung function or blood tests, then there will be an additional charge for this from a third-party provider.
• For patients who have not been under the care of our consultants, or have been in the past but have not been seen by them for over a year, then assessment will be a broader process that will be done through a regular appointment with any of our 3 consultants and charged at their usual practice rates as there may be a need for lung function tests to assess any asthma as well as skin or blood tests to ensure we have a full picture of all the child’s allergy and other medical issues.

We will aim, as far as possible, not to offer an assessment appointment if it is apparent from the details provided on this suitability form that treatment will not be suitable.

If your child is suitable for treatment and you wish to go ahead, then the cost of the treatment package is £18,000. A payment plan is available.

Treatment costs cover three key areas of the treatment:

• The cost of the medication e.g. a one-year course of PALFORZIA medication, which includes all pharmacy handling charges and, where required, delivery by our GPhC registered pharmacy partner, Boots.
• The cost of the daycare facilities at Great Ormond Street Hospital for Children, including any costs that may result from additional treatment required that is directly related to the desensitisation process e.g. management of allergic reactions, admission to general paediatric wards or intensive care.
• The costs of delivering the treatment by the Food Allergy Immunotherapy Centre such as consultant and specialist nursing time, administration and other staff and operating costs.

What is included in the package?

The package cost includes all aspects of the peanut OIT process for the first year. This includes:

• Initial dose escalation visit – this will take 4-5 hours and include 4 or 5 increasing doses. It will also be an opportunity to discuss the treatment with the specialist nurse, ensure you know how to recognise and treat any allergic reactions and have a chance to ask any questions. You will be provided with high quality supporting information to help you on your journey
• Provision of all PALFORZIA capsules for the first year of treatment, via our pharmacy partner Boots, including the cost of sending you any additional treatment if you are unable to attend scheduled visits.
• Ongoing support via our specialist nurse or doctors throughout the process of daily home dosing – you can reach us by phone or email, 7 days a week.
• All subsequent dose escalation visits – there are typically 11 of these over a 6 to 8 month period, all taking place in our dedicated day-case facility in the International & Private Patient wing of Great Ormond Street Hospital for Children.
• Any additional visits that may be required e.g. if a prolonged gap in treatment or illness requires additional dose escalation visits.
• Support from a specialist dietician, where required, to help manage any issues relating to consuming the PALFORZIA dose.
• Any costs that may result from additional treatment required that is directly related to the desensitisation process e.g. management of allergic reactions, admission to the private general paediatric ward or intensive care at Great Ormond Street Hospital as part of a dose escalation visit.
• Additional medical consultations relating to side effects to the treatment (excluding those requiring input from other medical specialities).
• A final consultation at the end of the first year of treatment and, if desired, a ‘transition’ challenge to move from PALFORZIA capsules to peanut in its natural form, for ongoing dosing.

What is not included?

The initial assessment visit, to consider suitability and consent, is not part of the package price. This visit will be charged at £300 (if allergy blood testing or oral food challenge is required, there may be an additional charge), which is non-refundable regardless of the final decision whether to progress to the treatment or not. We will aim, as far as possible, not to offer an assessment appointment if it is apparent from the details provided on our pre-assessment form that treatment will not be suitable.

We are not able to offer medical support for other food allergies or other allergic conditions as part of the package but consultations can be arranged with your lead consultant if required, at their usual fees. Issues relating to eczema and asthma, that directly relate to the desensitisation treatment will be included.

Consultations with our allergy specialists relating to side effects of the treatment will be included but if these require the input of non-allergy specialists e.g. a gastroenterologist for suspected eosinophilic oesophagitis, these will be subject to their usual fees.

The package includes a supply of PALFORZIA for the first year of treatment only. Beyond this, regular doses of peanut are required either in the form of PALFORZIA (for which there will be subsequent prescription costs) or in the form of native peanut (e.g. a measured amount of peanut butter or plain peanut). This decision can be discussed at the final consultation at the end of treatment. If you wish to convert from PALFORZIA to native peanut e.g. peanut butter, peanuts and wish to try these for the first time under supervision, then this is included in your package.

Follow up is recommended at annual intervals, once the first year of treatment has been completed. This can be with a specialist of your choice and would be billed at their standard consultation rates.

Evidence from clinical trials demonstrates that longer term use of PALFORZIA, can result in an increased tolerance of peanut, for example after 3 months of maintenance treatment, most children were able to tolerate a dose of 1000mg of peanut protein (around 4 peanuts) without a significant reaction. However to establish the level of tolerance of each child, food challenges are required. Whilst we do offer these, they are not an essential part of the treatment and are not included in the price. The value and timing of any subsequent food challenges can be discussed with the clinical team during your treatment.

Are there any additional costs?

We aim to be as transparent as possible about our fees as outlined above and if you have any questions about these, please feel free to contact us on office@oit.clinic or 0203 633 9851. If you are not happy with any aspect of the care you receive, please let us know as soon as possible. We will aim to address any issues as a matter of urgency but have a complaints policy, available here, if you are not satisfied.

What happens if my child cannot complete the treatment programme?

Not everybody completes the whole OIT program. This may be due to logistical difficulties attending appointments, your child not complying with daily dosing or due to side effects. You are of course free to stop treatment at any time and there is a clear refund policy that relates to how far into the program your child advanced. Once treatment has started, full refunds are not possible because of the costs of both the PALFORZIA medication and the cost of the use of the facilities at Great Ormond Street Hospital for Children, neither of which are refundable to us.

If you change your mind before the Initial Escalation visit – full refund minus a £250 administration fee (a further charge of £250 will be applied if less than 7 days’ notice is given).

If you do not progress beyond the Initial Escalation visit – 70% refund minus a £250 administration fee.

If you stop treatment after the Initial Escalation visit but before the 6^th up dosing visit – 50% refund minus a £250 administration fee. Please note that if treatment period has been longer than 3 months from Initial Escalation visit, then additional medication will also be charged for, at cost price.

If you stop treatment after the 6^th up dosing visit but before the 10^th up dosing visit – 25% refund minus a £250 administration fee. Please note that if treatment period has been longer than 4 months from Initial Escalation visit, then additional medication will also be charged for, at cost price.

If you stop treatment after the 10^th up dosing visit – no refund.

Are there any payment plans to help me spread the cost?

We acknowledge that the cost of treatment can cause a financial strain but likewise much of the cost involved is related to the early part of the treatment, when most of the on-site visits occur. We are able to offer a payment plan, where the cost of the treatment is spread over the first 6 months. This incurs a £100 administration fee on each of 3 payments.

Payment 1 – must be received prior to Initial Escalation visit – 50% of total

Payment 2 – 2 months after Initial Escalation visit – 25% of total

Payment 3 – 4 months after Initial Escalation visit – 25% of total

Can I get this treatment cheaper elsewhere?

We have prioritised safety in our treatment model and as a result, dose escalation visits are carried out in the safest possible place – a world renowned children’s hospital with immediate access to all their emergency facilities in the very unlikely scenario of a severe reaction. We also pride ourselves on being led by three world renowned allergy specialists all with long experience of food desensitisation programmes. It may be possible to receive PALFORZIA treatment more cheaply elsewhere but we do not believe any price is worth compromising on safety and expertise.

What happens after the first year of treatment?

If peanut desensitisation has been successful, then continued doses are required to maintain the effect in the longer term. There are 3 options to consider at the end of the first year of treatment:

• Continue with daily PALFORZIA at 300mg ie one sachet per day – this will require further ongoing prescriptions at approximately £400 per month.
• Continue taking an equivalent amount of peanut protein in a different form on a daily basis e.g. peanut butter, peanut M&Ms
• Stop regular peanut consumption but this would lead to a loss of the effect gained by desensitisation.

These options will be discussed at your exit consultation and if necessary, the first dose of peanut in the non-PALFORZIA form given under supervision, which is included in your package price.