2025 Southeastern Residency Conference

Title: 
Cost-Benefit Analysis of Inpatient Penicillin Allergy Assessment


Authors: Ted Holmes III; Melissa Padgett; Caitlin Ellis


Objective: 
Identify the positive effects of penicillin allergy de-labeling.


Self-Assessment Question: 
Which of the following has been associated with penicillin allergy de-labeling?


Background: 
Across most healthcare institutions, documented allergies result in avoidance of those medications, even if the reaction is unknown. However, up to 95% of patients either have an adverse effect incorrectly labeled as a penicillin allergy or have a childhood allergy. These inconsistencies put the patients at risk for receiving less effective treatment and adverse outcomes. To make matters worse, these alternative therapies may also increase costs for the patient and the facility. The purpose of this study is to analyze the cost impact of patients with documented penicillin allergies who are receiving inpatient antibiotics.


Methods:
This is a single-center, cost-benefit analysis conducted at a 515-bed academic hospital. Adults who were prescribed antibiotics and had a documented penicillin allergy or intolerance were included. Patients were excluded if they received antibiotics for less than 48 hours (both cohorts) or those who were unwilling or unable to participate in the interview (penicillin allergy clarification cohort only). Included patients were divided into two cohorts: those who received penicillin allergy clarification (pharmacy intervention) and those who did not receive an intervention. The primary endpoint was the total cost of antibiotics calculated from the average wholesale price, derived from publicly available resources. The secondary endpoints were antibiotic days of therapy and hospital length of stay.


Results:
Two hundred and sixty-eight patients were included in the study. The primary outcome of total cost of antibiotics was $240.80 and $254.60 for cohorts 1 and 2 respectively (p=0.7270). Cohort 1 had an average of 9.7 days of antibiotic therapy as compared to 8.9 days in Cohort 2 (p=0.4783). The average length of stay was 6.7 days in Cohort 1 and 5.6 days in Cohort 2 (p=0.0886).


Conclusion:
Although there was no statistically significant difference between any of the outcomes, there was a trend towards higher utilization of penicillins and lower utilization of carbapenems in patients who had their allergy clarified. As seen in other studies, potential cost savings may be due to the shorter length of hospital stay observed in patients who have had their allergy clarified. Larger studies are warranted to determine the true financial implications of penicillin allergy de-labeling.


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