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A Comprehensive Prospective Study of Costs Associated to the Evaluation of beta-lactam Allergy

Sobrino-García M1, Muñoz-Bellido FJ1,2,3, Moreno E1,2,3,4, Macías E1,2,3, Gracia-Bara MT1,2, Laffond E1,2,3, Lázaro-Sastre M1, Martín-García C1, de Arriba-Méndez S1,2,3, Campanón-Toro MV1, Gallardo-Higueras A1, Dávila I1,2,3,4

1Allergy Service, University Hospital of Salamanca, Spain
2Institute for Biomedical Research of Salamanca, IBSAL, Salamanca, Spain
3Department of Biomedical and Diagnostic Sciences, Faculty of Medicine. University of Salamanca, Spain
4Asthma, Allergic and Adverse Reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Salamanca University Hospital, Salamanca, Spain

J Investig Allergol Clin Immunol 2021; Vol. 31(1)
doi: 10.18176/jiaci.0457

Background: Being labelled as allergic to penicillin or unverified beta-lactam allergy result in patients receiving broader-spectrum antibiotics that may be more toxic, less effective, and/or with a higher cost.
Objective: We aimed to evaluate real costs of beta-lactam allergy evaluation.
Methods: A prospective real life observational study designed to evaluate all adult patients that consulted during one year for suspected beta-lactam allergy. Direct and indirect costs were systematically recorded. Direct health costs were calculated by taking into account the number of visits and all complementary and diagnostic tests performed; direct non-health costs by considering the number of visits and the kilometers from their homes to the Allergy Service; and indirect costs by considering the absenteeism.
Results: A total of 296 patients with suspected allergy to beta-lactams were evaluated in our outpatient clinic from June 1st, 2017 to May 31th, 2018. Total direct health care costs were €28,176.70, with a mean cost and a standard deviation (SD) of €95.19 (37.20). Direct non-health costs reached €6,551.73, 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, which means a cost per patient of €187.49 (148.14).
Conclusions: Even considering all possible costs, the evaluation of beta-lactam allergy is not expensive and can save future expenses due to unnecessary use of more expensive and less effective antibiotics.

Key words: Beta-lactam allergy, Delabelling, costs, Pharmacoeconomics, Penicillin allergy evaluation