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ABSTRACT: Background
Unverified penicillin allergy leads to adverse downstream clinical and economic sequelae. Penicillin allergy evaluation can be used to identify true, IgE-mediated allergy.Objective
To estimate the cost of penicillin allergy evaluation using time-driven activity-based costing (TDABC).Methods
We implemented TDABC throughout the care pathway for 30 outpatients presenting for penicillin allergy evaluation. The base-case evaluation included penicillin skin testing and a 1-step amoxicillin drug challenge, performed by an allergist. We varied assumptions about the provider type, clinical setting, procedure type, and personnel timing.Results
The base-case penicillin allergy evaluation costs $220 in 2016 US dollars: $98 for personnel, $119 for consumables, and $3 for space. In sensitivity analyses, lower cost estimates were achieved when only a drug challenge was performed (ie, no skin test, $84) and a nurse practitioner provider was used ($170). Adjusting for the probability of anaphylaxis did not result in a changed estimate ($220); although other analyses led to modest changes in the TDABC estimate ($214-$246), higher estimates were identified with changing to a low-demand practice setting ($268), a 50% increase in personnel times ($269), and including clinician documentation time ($288). In a least/most costly scenario analyses, the lowest TDABC estimate was $40 and the highest was $537.Conclusions
Using TDABC, penicillin allergy evaluation costs $220; even with varied assumptions adjusting for operational challenges, clinical setting, and expanded testing, penicillin allergy evaluation still costs only about $540. This modest investment may be offset for patients treated with costly alternative antibiotics that also may result in adverse consequences.
SUBMITTER: Blumenthal KG
PROVIDER: S-EPMC5862726 | biostudies-literature | 2018 May - Jun
REPOSITORIES: biostudies-literature
Blumenthal Kimberly G KG Li Yu Y Banerji Aleena A Yun Brian J BJ Long Aidan A AA Walensky Rochelle P RP
The journal of allergy and clinical immunology. In practice 20170922 3
<h4>Background</h4>Unverified penicillin allergy leads to adverse downstream clinical and economic sequelae. Penicillin allergy evaluation can be used to identify true, IgE-mediated allergy.<h4>Objective</h4>To estimate the cost of penicillin allergy evaluation using time-driven activity-based costing (TDABC).<h4>Methods</h4>We implemented TDABC throughout the care pathway for 30 outpatients presenting for penicillin allergy evaluation. The base-case evaluation included penicillin skin testing a ...[more]