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Objective Approximately 10% of pregnant individuals report a penicillin allergy, yet most are not truly allergic. Allergy verification during pregnancy is safe and recommended; however, many hospitals lack the infrastructure to execute testing. Our aim was to evaluate the cost of developing and implementing a penicillin allergy referral program for pregnant individuals at an academic institution and to compare costs of care between patients who were referred and not referred through the program.

Study Design We conducted an economic analysis of our institution's antepartum penicillin allergy referral program. We prospectively collected detailed resource utilization data and conducted the analysis from the program's perspective, accounting for costs related to program development, allergy verification, antibiotic cost, and delivery hospitalization. Costs were compared between patients who were referred for evaluation versus patients who were not referred using bivariate tests as well as quantile regression adjusting for baseline differences. A sensitivity analysis was performed for allergy testing cost. All cost estimates were inflation adjusted to 2021 U.S. dollars.

Results The startup cost of program development and educational initiatives was $19,920, or $86 per patient. The median allergy evaluation cost was $397 (interquartile range: $303–$663). There was no significant difference in maternal (median: $13,579 vs. $13,999, p = 0.94) or neonatal (median: $3,565 vs. $3,577, p = 0.55) delivery hospitalization cost or antibiotic cost (median: $1.57 vs. $3.87, p = 0.10) between referred and nonreferred patients. Overall, the total cost per person did not differ significantly between study groups (median: $18,931 vs. $18,314, p = 0.69).

Conclusion The cost of developing a penicillin allergy referral program in pregnancy was modest and did not significantly alter short-term cost of care with potential for long-term cost benefit. Verification of a reported penicillin allergy is an integral part of antibiotic stewardship, and the pregnancy period should be utilized as an important opportunity to perform this evaluation.

Key Points

The cost of developing and implementing an antepartum penicillin allergy referral program is modest.

Program cost did not significantly alter short-term cost with a potential for long-term cost benefit.

Penicillin allergy verification is an important part of antibiotic stewardship and should be expanded.

Keywords allergy in pregnancy - penicillin allergy - β-lactam allergy - allergy - cost - referral program Note

This study was orally presented at the 43rd Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, San Francisco, California, February 6 − February 11, 2023.

Publication History

Received: 30 November 2023

Accepted: 26 February 2024

Accepted Manuscript online:
29 February 2024

Article published online:
21 March 2024

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