Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study

Ismael Carrillo-Martin, Matthew G. Dudgeon, Natalia Chamorro-Pareja, Daniela A. Haehn, Maritza G. Rivera-Valenzuela, Aaron Spaulding, Michael G. Heckman, Nancy N. Diehl, Joan M. Irizarry-Alvarado, Haytham Helmi, Alexei Gonzalez-Estrada

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Chronic urticaria/angioedema (CUA) guidelines recommend limiting tests to diagnose and assess prognosis, activity, and severity. Routine testing in CUA might substantially increase cost of disease without benefiting outcome. Objective: To evaluate the utility of tests in CUA and how they influence the cost of disease. Methods: We reviewed 725 electronic medical records of patients who were evaluated for CUA between 2010 and 2018 at a tertiary care center. The sample was gathered through the search of International Classification of Diseases Ninth and Tenth Revision codes pertaining to CUA. Analyses were made to evaluate changes in outcome for patients on whom at least 1 test was performed to evaluate CUA, the costs generated by these tests, and the tendencies to order specific tests from 2010 through 2018. Results: Of 725 patients (age median, 47 years; women, 73.1%), 543 (74.8%) had at least 1 test performed. Tests had an elevated percentage of normal results (>90%). Five patients (0.9%) had a change in outcome and 8 patients were given a different diagnosis (0.1% each). Evaluation, management, and tests accounted for most of the costs. Costs remain similar between 2010-2014 (mean, $569) and 2015-2018 (mean, $569). Conclusions: In CUA, tests rarely uncover underlying conditions or lead to changes in management and outcome, but they substantially increase the costs generated by the disease. Adherence to current recommendations to limit testing might help in reducing the financial burden of CUA and improve delivery of care.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StatePublished - Jan 1 2019

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Angioedema
Urticaria
Cohort Studies
Costs and Cost Analysis
Cost of Illness
Electronic Health Records
International Classification of Diseases
Tertiary Care Centers
Guidelines

Keywords

  • Changes in outcome
  • Chronic urticaria
  • Costs
  • Tests
  • Utility

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Carrillo-Martin, I., Dudgeon, M. G., Chamorro-Pareja, N., Haehn, D. A., Rivera-Valenzuela, M. G., Spaulding, A., ... Gonzalez-Estrada, A. (2019). Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study. Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2019.04.031

Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema : A Cohort Study. / Carrillo-Martin, Ismael; Dudgeon, Matthew G.; Chamorro-Pareja, Natalia; Haehn, Daniela A.; Rivera-Valenzuela, Maritza G.; Spaulding, Aaron; Heckman, Michael G.; Diehl, Nancy N.; Irizarry-Alvarado, Joan M.; Helmi, Haytham; Gonzalez-Estrada, Alexei.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2019.

Research output: Contribution to journalArticle

Carrillo-Martin, I, Dudgeon, MG, Chamorro-Pareja, N, Haehn, DA, Rivera-Valenzuela, MG, Spaulding, A, Heckman, MG, Diehl, NN, Irizarry-Alvarado, JM, Helmi, H & Gonzalez-Estrada, A 2019, 'Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study', Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2019.04.031
Carrillo-Martin, Ismael ; Dudgeon, Matthew G. ; Chamorro-Pareja, Natalia ; Haehn, Daniela A. ; Rivera-Valenzuela, Maritza G. ; Spaulding, Aaron ; Heckman, Michael G. ; Diehl, Nancy N. ; Irizarry-Alvarado, Joan M. ; Helmi, Haytham ; Gonzalez-Estrada, Alexei. / Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema : A Cohort Study. In: Journal of Allergy and Clinical Immunology: In Practice. 2019.
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abstract = "Background: Chronic urticaria/angioedema (CUA) guidelines recommend limiting tests to diagnose and assess prognosis, activity, and severity. Routine testing in CUA might substantially increase cost of disease without benefiting outcome. Objective: To evaluate the utility of tests in CUA and how they influence the cost of disease. Methods: We reviewed 725 electronic medical records of patients who were evaluated for CUA between 2010 and 2018 at a tertiary care center. The sample was gathered through the search of International Classification of Diseases Ninth and Tenth Revision codes pertaining to CUA. Analyses were made to evaluate changes in outcome for patients on whom at least 1 test was performed to evaluate CUA, the costs generated by these tests, and the tendencies to order specific tests from 2010 through 2018. Results: Of 725 patients (age median, 47 years; women, 73.1{\%}), 543 (74.8{\%}) had at least 1 test performed. Tests had an elevated percentage of normal results (>90{\%}). Five patients (0.9{\%}) had a change in outcome and 8 patients were given a different diagnosis (0.1{\%} each). Evaluation, management, and tests accounted for most of the costs. Costs remain similar between 2010-2014 (mean, $569) and 2015-2018 (mean, $569). Conclusions: In CUA, tests rarely uncover underlying conditions or lead to changes in management and outcome, but they substantially increase the costs generated by the disease. Adherence to current recommendations to limit testing might help in reducing the financial burden of CUA and improve delivery of care.",
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