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Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis
Matthew Y Liu1,2, Megana Challa2, Edward D McCoul3,4
1Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
Objective:
Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery.
Methods:
A break-even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR.
Results:
Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability.
Conclusion:
In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery.
Level Of Evidence:
NA Laryngoscope, 133:1086-1091, 2023.
Insights
Penicillin allergy testing is economically feasible for otolaryngology patients, preventing unnecessary clindamycin use and associated risks like C. difficile infections (CDI) and surgical site infections (SSI). This testing can reduce healthcare costs and improve patient safety.
Area of Science:
- Otolaryngology
- Infectious Disease
- Health Economics
Background:
- Mislabeled penicillin allergies lead to unnecessary clindamycin use in otolaryngology.
- Clindamycin increases risks of Clostridioides difficile infections (CDI) and surgical site infections (SSI).
Purpose of the Study:
- To evaluate the economic feasibility of penicillin allergy testing.
- To determine if testing prevents unnecessary clindamycin use in otolaryngologic surgery patients with unconfirmed allergies.
Main Methods:
- Break-even analysis to determine the required absolute risk reduction (ARR) for economic sustainability.
- Binomial distribution used to calculate the probability of achieving target ARRs.
Main Results:
- Testing is economically sustainable if it reduces baseline CDI by 1.06% or SSI by 1.34% ARR.
- Economic sustainability is guaranteed if baseline CDI is at least 5% or SSI is at least 7%.
Conclusions:
- Preoperative penicillin allergy testing is an economically viable strategy.
- Guidelines should recommend testing for patients with unconfirmed penicillin allergies before otolaryngologic surgery.
