A Prospective Study of Costs Associated With the Evaluation of β-Lactam Allergy in Children

Abstract

To evaluate the cost of elective evaluation of β-lactam drug allergies in children.In this study, researchers included any children, up to the age of 14 years, with a suspected hypersensitivity reaction to β-lactam antibiotics who were seen in the outpatient allergy clinic at the University Hospital of Salamanca, Spain. No testing was done on patients with a history of a nonimmediate severe cutaneous reaction.This study was a prospective, observational study performed from June 2017 to May 2018. Testing included skin prick, intradermal tests, and oral challenges. Costs were broken down into direct health care costs, direct non–health care costs, and indirect non–health care costs. Direct health care costs were calculated on the basis of the number of health care visits and testing performed. Direct non–health care costs included transportation costs for families, and indirect non–health care costs were estimated on the basis of missed work for visit appointments.A total of 40 children met inclusion criteria during the year long study (median age: 4 years; range: 0–13 years). Only 3 patients (7.5%) were diagnosed with β-lactam allergy on the basis of positive intradermal skin testing to amoxicillin. A median of 3 office visits per patient were required for evaluation and diagnosis. The mean total cost per patient for evaluation of β-lactam allergy was $308.11 (range: $116.44–$835.36), with a mean direct health care cost of $125.95 per patient, mean direct non–health care cost of $22.55 per patient, and mean indirect non–health care cost of $159.61 per patient.The cost of elective evaluation of β-lactam allergy in pediatric patients is relatively inexpensive, with a mean total cost of $308.11 per patient.Previous studies have revealed that the majority of children labeled with β-lactam allergy do not have true drug allergy, and avoidance of β-lactam antibiotics is associated with increased antimicrobial resistance and use of more expensive antibiotics. This study reveals that outpatient evaluation of β-lactam allergies is relatively inexpensive and may reduce long-term health care costs. Of note, this study was done in Spain, but the authors point out that the total cost of evaluation of β-lactam allergy was similar to that of other studies done with adults in the United States.