Abstract
Background
β-Lactams remain the gold standard for treatment of MSSA bacteremia due to superior outcomes compared with vancomycin. Approximately nine in 10 patients receiving penicillin skin testing (PST) will be de-labeled of a penicillin allergy and able to receive a β-lactam antibiotic. The study aims to evaluate the cost-effectiveness of penicillin allergy confirmation during acute care admission for methicillin-sensitive staphylococcus aureus (MSSA) bacteremia through a PST service.
Methods
A decision tree analysis was used to compare a PST intervention in patients with a registeredpenicillin allergy during an inpatient admission for MSSA bacteremia vs. usual care (No PST). The model was created from the health sector perspective with a 1-year time horizon. Patients with a penicillin allergy label were expected to receive vancomycin while patients with no penicillin allergy were expected to receive cefazolin. Potential inpatient, outpatient, and adverse reaction costs were considered in all arms of the model. The effects were measured in quality adjusted life years (QALY) and were calculated for patients who were cured, hospitalized, experienced severe adverse events, or died from MSSA infection.
Results
Patients who received PST services had a mean yearly cost of $12,802, mean quality adjusted life years (QALY) of 0.70, and mean cost/QALY of $18,311. The comparator group not receiving PST services had a mean yearly cost of $12,264, mean quality adjusted life years (QALY) of 0.64, and mean cost/QALY of $19,192. The model produced a final base case ICERof $8,966/QALY for receiving a PST during a hospital admission for the treatment of methicillin-sensitive staphylococcus aureus (MSSA) bacteremia.
Conclusion
Penicillin allergy confirmation through PST services was cost-effective for patients with a reported penicillin allergy admitted for MSSA bacteremia. Additional research to determine potential benefits of PST services beyond one year could further improve the cost-effectiveness of this intervention.
Disclosures
S. Meninger, ALK-Abelló: Grant Investigator, Research grant. E. Heil, ALK-Abelló: Grant Investigator, Research grant. T. J. Mattingly II, ALK-Abelló: Grant Investigator, Research grant.
Session: 137. Healthcare Epidemiology: MSSA, MRSA and Other Gram Positive Infections
Friday, October 5, 2018: 12:30 PM