The cost of self-reported penicillin allergy: a systematic review

Publication date: Available online 31 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): T. Joseph Mattingly, Anne Fulton, Rachel A. Lumish, Anne M.C. Williams, SeJeong Yoon, Melissa Yuen, Emily L. Heil
BackgroundPatients who report a penicillin (PCN) allergy receive suboptimal antibiotic therapy compared to patients not reporting an allergy. However, a majority of patients who report PCN allergy are not truly allergic upon confirmatory testing. Ruling out PCN allergy by testing may improve clinical and economic outcomes for patients with reported allergies requiring antibiotic therapy.ObjectivesTo summarize clinical and economic outcomes associated with PCN allergy and provide recommendations for future cost-effectiveness analyses for PCN allergy testing.MethodsA literature search was conducted using SCOPUS, EMBASE, and PubMed, including all articles published any date through April 25, 2017 (PROSPERO Registration number 42017064112). A total of 1,518 abstracts were found during the initial search with 96 duplicates, for a total of 1,422 articles for screening. Thirty articles were included for qualitative synthesis and full data extraction.ResultsThe majority of the studies included had an observational design focusing on inpatient admissions. The most frequently measured outcome in the context of PCN allergy was optimizing antibiotic therapy. Patients with PCN allergy were found to have direct drug costs during inpatient admission ranging from no difference to an additional $609/patient compared to non-PCN allergy patients. Outpatient prescription costs were estimated from $14-$193/patient higher for PCN allergic patients. Total inpatient costs were less for non-PCN allergy patients with average savings from $1,145-$4,254/patient.ConclusionsEvaluations of clinical and economic outcomes of PCN allergy are primarily observational and focus on inpatient populations. Long-term relationships between PCN allergy and clinical and economic outcomes are unknown.