Cost-effectiveness of patch testing allergens within the same group: A computational approach to optimize formaldehyde-related allergen selection.
J Am Acad Dermatol
; 2024 Jul 05.
Article
in En
| MEDLINE
| ID: mdl-38972480
ABSTRACT
BACKGROUND:
Patch testing for multiple cross-reactive allergens for allergic contact dermatitis (ACD) may not be necessary because of copositivity.OBJECTIVES:
We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test.METHODS:
A retrospective analysis of Mayo Clinic (1997-2022) examined the well-established copositive formaldehyde group formaldehyde, quaternium 15, hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, diazolidinyl urea, imidazolidinyl urea, toluenesulphonamide formaldehyde resin, DMDM hydantoin, and ethyleneurea melamine formaldehyde mix. Patch Optimization Platform identified which single formaldehyde-related allergen optimally captures patients with clinically relevant ACD. Next, Patch Optimization Platform determined the optimal additional 1, 2, 3, etc. allergens. Cost per patch test was $5.19 (Medicare 2022).RESULTS:
A total of 9832 patients were tested for all listed allergens, with 830 having positive patch test results. Patch Optimization Platform determined that quaternium 15 alone captures 53% of patients with ACD to the formaldehyde group; adding the optimal second allergen (formaldehyde 1%) captures 78%; the optimal 5 top allergens capture >94% of patients. The incremental cost per additional diagnosis increased up to 44-fold as the number of allergens tested increased.LIMITATIONS:
Data are from a single institution, and the cost per test was fixed according to Medicare Part B in 2022.CONCLUSIONS:
For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.
Full text:
1
Database:
MEDLINE
Language:
En
Year:
2024
Type:
Article