%0 Journal Article
%T Cost-effectiveness of patch testing allergens within the same group: A computational approach to optimize formaldehyde-related allergen selection.
%A McKenzie NC
%A Buras MR
%A Yiannias JA
%A Hall MR
%A Youssef MJ
%A Davis MDP
%A Yang YW
%J J Am Acad Dermatol
%V 0
%N 0
%D 2024 Jul 5
%M 38972480
%F 15.487
%R 10.1016/j.jaad.2024.06.061
%X <B>BACKGROUND: </B>Patch testing for multiple cross-reactive allergens for allergic contact dermatitis (ACD) may not be necessary because of copositivity.<BR><B>OBJECTIVE: </B>We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test.<BR><B>METHODS: </B>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).<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Data are from a single institution, and the cost per test was fixed according to Medicare Part B in 2022.<BR><B>CONCLUSIONS: </B>For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.