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A Comprehensive Prospective Study of the Costs Associated With Evaluation of ß-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, Salamanca, Spain
2Institute for Biomedical Research of Salamanca, IBSAL, Salamanca, Spain
3Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, 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) : 52-57
doi: 10.18176/jiaci.0457

Background: Being labeled as allergic to penicillin (unverified ß-lactam allergy) can result in patients receiving broader-spectrum antibiotics than necessary that may be more toxic, less effective, and/or more expensive than alternative options.
Objective: We aimed to evaluate the real costs of evaluating ß-lactam allergy.
Methods: We performed a prospective real-life observational study designed to evaluate all adult patients who consulted for suspected ß-lactam allergy over a 1-year period. Direct and indirect costs were systematically recorded. Direct health costs were calculated based on the number of visits and all additional and diagnostic tests performed, direct nonhealth costs based on the number of visits and the distance from their homes to the Allergy Department, and indirect costs based on absenteeism.
Results: A total of 296 patients with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct health care costs were €28 176.70, with a mean (SD) cost of €95.19 (37.20). Direct nonhealth costs reached €6551.73, 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, that is, a cost per patient of €187.49 (148.14).
Conclusions: When all possible costs are taken into account, the evaluation of ß-lactam allergy is not expensive and can reduce future expense arising from unnecessary use of more expensive and less effective antibiotics.

Key words: ß-Lactam allergy, Delabeling, Costs, Pharmacoeconomics, Penicillin allergy evaluation