A Comprehensive Prospective Study of the Costs Associated With Evaluation of ß-Lactam Allergy

Abstract

Background: Being labeled as allergic to penicillin (unverified ß-lactam allergy) can result in patients receiving broader-spectrum antibiotics than necessary that may be more toxic, less effective, and/or more expensive than alternative options. Objective: We aimed to evaluate the real costs of evaluating ß-lactam allergy. Methods: We performed a prospective real-life observational study designed to evaluate all adult patients who consulted for suspected ß-lactam allergy over a 1-year period. Direct and indirect costs were systematically recorded. Direct health costs were calculated based on the number of visits and all additional and diagnostic tests performed, direct nonhealth costs based on the number of visits and the distance from their homes to the Allergy Department, and indirect costs based on absenteeism. Results: A total of 296 patients with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct health care costs were €28 176.70, with a mean (SD) cost of €95.19 (37.20). Direct nonhealth costs reached €6551.73, that is, €22.13 (40.44) per patient. Indirect health costs reached €20 769.20, with a mean of €70.17 (127.40). In summary, the total cost was €55 497.63, that is, a cost per patient of €187.49 (148.14). Conclusions: When all possible costs are taken into account, the evaluation of ß-lactam allergy is not expensive and can reduce future expense arising from unnecessary use of more expensive and less effective antibiotics.

Analysis of the Costs Associated With the Elective Evaluation of Patients Labelled as Allergic to Beta-Lactams or Nonsteroidal Antiinflamatory Agents

“…Prospective studies about the costs of evaluating patients labeled as allergic to different drug such as beta-lactam in adults (Blumenthal et al, 2018;Sobrino-García et al, 2019) and children or NSAIDs (Sobrino-García et al, 2020) drive this field forward prioritized.…”

“…There was also a prospective study evaluating the costs of the evaluation of hypersensitivity to NSAIDs in adults. Direct and indirect costs as explained by Soto-Álvarez (2020) were systematically recorded in only a few studies (Blumenthal et al, 2018;Sobrino-García et al, 2019;Sobrino-García et al, 2020). Direct health costs were calculated by Blumenthal et al (2018), who analyzed personnel costs, consumables and space costs.…”

“…Direct health costs were calculated by Blumenthal et al (2018), who analyzed personnel costs, consumables and space costs. Moreover, other studies Sobrino-García et al, 2019;Sobrino-García et al, 2020) considered the number of consultations and all the diagnostic tests performed. Direct non-health costs Sobrino-García et al, 2019;Sobrino-García et al, 2020) were calculated taking into account the number of consultations and the distance from their homes to the Allergy service.…”

“…Moreover, other studies Sobrino-García et al, 2019;Sobrino-García et al, 2020) considered the number of consultations and all the diagnostic tests performed. Direct non-health costs Sobrino-García et al, 2019;Sobrino-García et al, 2020) were calculated taking into account the number of consultations and the distance from their homes to the Allergy service. Finally, indirect costs Sobrino-García et al, 2019;Sobrino-García et al, 2020) were calculated considering the absenteeism of patients.…”

“…In cases where more resources were used, assessment of penicillin allergy costs were around $540 (€482.45). In Europe (Spain, Sobrino-García et al, 2019) performed a prospective, oneyear-long study in 296 patients (46 positives), obtaining an average cost of €187.49, with a maximum cost of €789.96.…”