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Economic analysis of the penicillin skin test for antibiotic selection in the Intensive Care Unit FREE TO VIEW

Juan C. Chagoya, MD*; Adrienne Heerey, PhD; Enrique Diaz Guzman Zavala, MD; Steven Gordon, MD; Mercedes Arroliga, MD; Alejandro Arroliga, MD
Author and Funding Information

Cleveland Clinic Foundation, Cleveland, OH


Chest. 2004;126(4_MeetingAbstracts):763S-c-764S. doi:10.1378/chest.126.4_MeetingAbstracts.763S-c
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PURPOSE:  Although 20% of patients have history of penicillin allergy, up to 88.5% of them have a negative Penicillin Skin Test (PST) in the ICU. If not tested, these patients receive an alternative antibiotic. This may be associated with higher rates of resistance and extra cost of care. PST potentially may reduce these associated expenses. The goals of this study are to investigate cost differences and the cost benefit of the PST in the ICU.

METHODS:  A group of “penicillin allergic” patients admitted to the ICU who received PST were compared to a matched group. Patient charts were reviewed for antibiotic selection and treatment success or failure. Charges were derived from the hospital accounting database (Eclipses®) and converted to costs using departmental cost to charge ratios derived form the 2002 Medicare cost report. Cost included the cost of PST ($100 USD in the region), medications and treating a patient in the hospital setting. A decision analytical model was developed using Treeage Data® V4.0 to investigate any cost benefit of the PST.

RESULTS:  Two groups of 27 patients were compared. Eighty one percent of the patients who received a PST were negative. The median cost of treating the PST group patients was not different from the control group: $35,003 vs. $29,166 (p=0.68). Treatment success was also not different: 78% PST group vs. 85% Control group (p=0.48).

CONCLUSION:  No significant difference was shown in terms of costs and rates of success between the PST and the control groups. The cost of the PST test was only a small fraction (0.28%) of overall cost of treatment.

CLINICAL IMPLICATIONS:  The PST does not increase the cost of hospitalization in the ICU, plus can provide valuable information on optimal, safe and cost effective antibiotic treatment.

DISCLOSURE:  J.C. Chagoya, None.

Tuesday, October 26, 2004

2:30 PM- 4:00 PM




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