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    Penicillin skin testing in methicillin-sensitive staphylococcus aureus bacteremia: A cost-effectiveness analysis

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    Author
    Joseph, Mattingly, T.
    Meninger, S.
    Heil, E.L.
    Date
    2019
    Journal
    PLoS ONE
    Publisher
    Public Library of Science
    Type
    Article
    
    Metadata
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    See at
    https://dx.doi.org/10.1371/journal.pone.0210271
    Abstract
    Background Beta-lactams are the mainstay for treating methicillin-susceptible Staphylococcus aureus (MSSA) infections complicated by bacteremia due to superior outcomes compared with vancomycin. With approximately 11% of inpatients reporting a penicillin (PCN) allergy, many patients receive suboptimal treatment for MSSA bacteremia. Objective Evaluate the cost-effectiveness of penicillin skin testing (PST) in adult patients with self-reported PCN allergy in an inpatient setting undergoing treatment for MSSA bacteremia. Methods A decision analytic model was developed comparing an acute care PST intervention to a scenario with no confirmatory allergy testing. The primary outcome was the incremental cost-effectiveness ratio (ICER) from the health-sector perspective over a 1-year time horizon using quality-adjusted life years (QALYs) as the measure for effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the ICER estimation. Results Over a 1-year time horizon, PST services applied to all MSSA bacteremia patients reporting a PCN-allergy would result in a cost per patient of $12,559 and 0.73 QALYs while no PST services would have a higher cost per patient of $13,219 and 0.66 QALYs per patient. This resulted in a cost-effectiveness estimate of -$9,429 per QALY gained. Varying the cost of implementing PST services determined a break-even point of $959.98 where any PST cost less than this amount would actually be cost saving. Conclusions Patients reporting a PCN allergy on admission may receive sub-optimal alternative therapies to beta-lactams, such as vancomycin, for MSSA bacteremia. This economic analysis demonstrates that inpatient PST services confirming PCN allergy are cost-effective for patients with MSSA bacteremia. © 2019 Mattingly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Sponsors
    This study was supported by an unrestricted educational grant by ALK, Inc. The funding source had no role in the design and conduct of the study; collection, management, and analysis of the data; or preparation, review, and approval of the manuscript.
    Keyword
    Bacteremia
    Drug Hypersensitivity
    Penicillins
    Skin Tests--economics
    Staphylococcal Infections--complications
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059613884&doi=10.1371%2fjournal.pone.0210271&partnerID=40&md5=f9b0a04e5e4d15429c0a2a9356dade18; http://hdl.handle.net/10713/8553
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0210271
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