Economic Burden of Patient-Reported Penicillin Allergy on Total Hip and Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2021-09, Vol.36 (9), p.3067-3072
• Main Authors: Lee, Olivia C., Cheng, Darren C., Paul, Jonathan L., Ross, Bailey J., Hawkins, Barrett J., Sherman, William F.
• Format: Article
• Language: English
• Subjects: cost savings; economic burden; penicillin allergy; penicillin allergy testing; prosthetic joint infection; total joint arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2021.04.032

Self-reported penicillin allergies in patients undergoing total joint arthroplasty often results in the use of second-line prophylactic antibiotics. A higher risk of prosthetic joint infection (PJI) is associated with suboptimal antibiotics vs first generation cephalosporins, which have historically been grouped with other beta-lactam antibiotics such as penicillin for potential allergic reactions. This study evaluates the economic burden of self-reported penicillin allergies in total joint arthroplasty (TJA). Data from studies reporting true incidence of IgE-mediated penicillin allergies, infection-free survivorship of TJA, and cost of PJI attributed to use of second-line antibiotics were obtained. Projected cost of preoperative penicillin allergy testing and potentially avoidable PJI associated with second-line antibiotic usage were calculated. This was compared with projected cost of PJI in the current state to estimate cost savings. Implementation of preoperative penicillin allergy testing leads to a potential savings of nearly $37 million to payors in the first year based on 1-year survivorship. This savings increases to $411.6 million over a 10-year span and $1.18 billion over a 20-year span. Preoperative penicillin allergy testing or risk stratification via thorough history should be implemented as standard of care for patients with self-reported penicillin allergies before TJA and would result in decreased cost of PJI.