De-Labeling Penicillin Linked to Economic Benefits

Natasha K Brusco, PhD

A systemic review conducted in Australia found that de-labeling low-risk penicillin allergy in the inpatient setting setting had economic advantages.

Though investigators suggested “robustly designed and fully powered economic evaluations” of penicillin de-labeling to support their findings, they suggested that for patients already admitted to a hospital, penicillin de-labeling via direct de-labeling or an oral challenge was a more cost-effective way of delivering penicillin allergy testing compared to outpatient clinics or no penicillin de-labeling.

The investigative team, headed by Natasha K Brusco,PhD, Rehabilitation Stream Lead, Rehabilitation, Aging and Independent Living (RAIL) Research Centre, Monash University, cited a paucity of literature which detailed the economic impact of penicillin allergy in the context of Australia.

In their study, Brusco and colleagues determined if the economic advantages of low-risk inpatient penicillin de-labeling were realized in the Australian context, supporting changes to healthcare delivery system.

Methods

The economic evaluation conducted in the study was developed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

Additionally, the Penicillin Allergy De-labeling Program (PADP) commenced at the Austin Health and Peter MacCallum Cancer Center in Melbourne, with patients in in the inpatient setting.

Patients in the outpatient setting participated in the Outpatient Antibiotic Allergy Testing Service (OAATS).

The investigators then compared the 2 patient cohorts, and the effect was reported as the proportion of patients with a reported penicillin allergy label who were appropriately de-labeled.

The second part of the cohort study used a before and after study design comparing inpatients with a low-risk penicillin allergy, with an infective diagnosis, who underwent de-labeling via PADP with retrospective inpatients with a reported penicillin allergy who did not access PADP.

Inpatients from the PADP cohort admitted during the month of March 2019 were 1:1 matched with retrospective inpatients admitted during the month of May 2015.

Lastly, a 2-part statistical analysis was performed that evaluated the cost per effectively de-labeled patient for PADP versus OAATS, and the cost-comparison of inpatient admissions with and without access to PADP.

Results

For the first part of the analysis, the proportion of penicillin allergies de-labeled through PADP was 0.98 (n=344/350) while OAATS was 0.50 (n=18/36), this significantly favoring PADP ((p<0.001).

In comparing costs per effectively de-labeled patient PADP was associated with savings of $341.97 per effectively labelled patient, with the PADP resulting in costs of $20.51 per effectively de-labeled patient (i.e., $20.10/0.98) compared to $362.48 per effectively de-labeled patient in OAATS to costs of $362.48.

Brusco and team noted that a significant cost difference remained for the PADP cohort when the OAATS costs were reduced between 5% and 75% (p<0.001), but not when they were reduced by 90%.

Similar results were recorded in their cost-comparison of inpatient admissions with and without PADP access.

Brusco and investigators believed the data were consistent with international literature on de-labeling low-risk penicillin allergy, and economic advantages for Australian patients were noticeable. Further research was suggested.

“The consistency in the literature indicates that health services should be encouraged to implement similar programs and examine the cost advantages in their setting,” the team wrote.

The study, “Penicillin Allergy Delabeling Program: an exploratory economic evaluation in the Australian context,” was published online in the Internal Medicine Journal.