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Penicillin Allergy Delabeling Program: an exploratory economic evaluation in the Australian context
Natasha K Brusco1,2, Susan Bury3,4, Kyra Y L Chua3
1Health Economics, Alpha Crucis Group, Melbourne, Victoria, Australia.
Insights
Penicillin allergy delabelling in Australian hospitals is cost-effective, reducing patient costs and hospital stays. This supports integrating penicillin delabelling into routine inpatient care for economic benefits.
Area of Science:
- Health Economics
- Pharmacovigilance
- Clinical Allergy Management
Background:
- International studies highlight clinical and economic benefits of penicillin delabelling.
- Integrating penicillin delabelling into routine inpatient care is supported by healthcare delivery system changes.
Purpose of the Study:
- To evaluate the economic advantages of low-risk inpatient penicillin delabelling in Australia.
- To compare the cost-effectiveness of inpatient versus outpatient penicillin allergy testing.
Main Methods:
- An explorative economic evaluation using prospective patient data from two Australian health services (Jan-Aug 2019).
- Part 1 compared cost per effectively delabelled patient between the Penicillin Allergy Delabeling Program (PADP) inpatient cohort and Outpatient Antibiotic Allergy Testing Service (OAATS) outpatient cohort.
- Part 2 compared hospital costs for inpatients with low-risk penicillin allergy who did (PADP) or did not (usual care) undergo delabelling.
Main Results:
- The PADP cohort incurred lower costs ($20.51 per effectively delabelled patient) compared to OAATS ($362 per effectively delabelled patient), indicating significant savings.
- Inpatient delabelling via PADP resulted in an average reduction of 4.41 days in hospital stay and savings of $9467.72 per patient compared to usual care.
- Outpatient allergy testing (OAATS) was found to be a dominated strategy, being more costly and less effective than inpatient delabelling.
Conclusions:
- Penicillin allergy delabelling in the inpatient setting demonstrates economic advantages within the Australian healthcare context.
- Findings align with international literature supporting the cost-effectiveness of penicillin delabelling.
- Further fully powered economic evaluations are recommended to solidify these findings.
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.
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