Penicillin Allergy Delabeling Program: an exploratory economic evaluation in the Australian context

Brusco, NK; Bury, S; Chua, KYL; Vogrin, S; Holmes, NE; Trubiano, JA

Author(s): Brusco, NK; Bury, S; Chua, KYL; Vogrin, S; Holmes, NE; Trubiano, JA;
Details: Publication Year 2023-01,Volume 53,Issue #1,Page 74-83
Journal Title: Internal Medicine Journal
Publication Type: Research article
Abstract: BACKGROUND: Internationally, clinical and economic advantages of low-risk penicillin delabelling have been explored, supporting changes to healthcare delivery systems where penicillin delabelling is embedded into inpatient usual care. AIMS: To determine if economic advantages of low-risk inpatient penicillin delabelling, described in the international literature, are realised in the Australian context. METHODS: This explorative economic evaluation had prospective patient data collection between January and August 2019, across two Australian health services. Part 1: determine the cost per effectively delabelled patient for Penicillin Allergy Delabeling Program inpatients (PADP cohort) compared with Outpatient Antibiotic Allergy Testing Service outpatients (OAATS cohort). Part 2: a cost analysis to compare hospital costs for inpatients with low-risk penicillin allergy who did (PADP cohort) and did not (usual care cohort) undergo PADP delabelling. RESULTS: Part 1: the PADP (n = 350) and OAATS (n = 27 patients, n = 36 individual visits) cohorts were comparable. In PADP, costs/proportion delabelled was $20.10/0.98, equating to $20.51 per effectively delabelled patient; in OAATS, it was $181.24/0.50, equating to $362. Compared with OAATS, PADP was associated with savings of $341.97 per effectively delabelled patient, indicating the outpatient testing was the dominated strategy, being more costly and less effective. Part 2: the PADP (n = 218) and usual care (n = 32) cohorts were comparable. Significantly favouring the delabelled PADP cohort, the mean difference per patient was -4.41 days (95% confidence interval: -7.64, -1.18) and -$9467.72 (95% confidence interval: -$15 419.98, -$3515.46). CONCLUSIONS: Consistent with international literature, delabelling low-risk penicillin allergies in the inpatient setting had economic advantages in the Australian context. Fully powered economic evaluations are urgently required to consolidate these findings.
Publisher: Wiley
Keywords: Humans; Cost-Benefit Analysis; Prospective Studies; Australia/epidemiology; Penicillins/adverse effects; Anti-Bacterial Agents/adverse effects; *Drug Hypersensitivity/diagnosis/epidemiology; *Hypersensitivity; Antibiotics; Delabeling; Health Economics; Health Service Research
Department(s): Infectious Diseases
PubMed ID: 34523209
Publisher's Version: https://doi.org/10.1111/imj.15532
Open Access at Publisher's Site: https://doi.org/10.1111/imj.15532
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-04-13 02:29:10

Last Modified: 2023-04-13 04:32:06