That treating patients based on an unverified allergy to penicillin has—perhaps expected, but yet unintended—consequences both in terms of outcomes and overall cost-of-care is well known.
What isn’t as well known is the exact scope of these issues.
Using time-driven activity-based costing (TDABC), a team of Massachusetts General Hospital (MGH)-based researchers sought to provide important insight into these questions, at a time when the medical field has been debating the practicality of performing a penicillin allergy evaluation in patients prior to initiating treatment. The results
of the TDABC assessment were published in the September 22, 2017, issue of the Journal of Allergy and Clinical Immunology: In Practice
The lead author of the JACIIP
paper, Kimberly G. Blumenthal, MD, MSc, Division of Rheumatology, Allergy and Immunology, Department of Medicine and Edward P. Lawrence Center for Quality and Safety, MGH, participated in a pro-con debate regarding implementation of penicillin allergy evaluation during the annual meeting of the American Academy of Allergy, Asthma, and Immunology in March 2017. A summary
of the discussion was also published in the September 22, 2017, issue of JACIIP
, and covered by Contagion®
earlier this month.
For the TDABC evaluation, Dr. Blumenthal and colleagues estimated the cost of penicillin allergy evaluation “throughout the care pathway” in 30 outpatients. The authors used a “base-case evaluation” that included penicillin skin testing and a 1-step amoxicillin drug challenge, which was performed by an allergist.
In the 30 outpatients, they found that the base-case penicillin allergy evaluation cost $220 (in 2016 US dollars). This figure included $98 for personnel, $119 for consumables, and $3 for space. In subsequent sensitivity analyses, the authors found that they were able to reduce costs by using only the drug challenge component of the evaluation. In this approach, performed under the supervision of nurse practitioners, total costs were $170.