An economic evaluation of direct oral penicillin challenge for de-labelling low risk patients with a penicillin allergy label
Bestwick, R Bhogal, R Kildonaviciute, K Ng, B Y Jackson, B Moriarty, C Thomas, C Savic, L Misbah, S A Krishna, M T
Bestwick, R
Bhogal, R
Kildonaviciute, K
Ng, B Y
Jackson, B
Moriarty, C
Thomas, C
Savic, L
Misbah, S A
Krishna, M T
Affiliation
University of Leeds; University Hospitals Birmingham NHS Foundation Trust; Oxford University Hospitals NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; University of Birmingham
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Publication date
2025-02-05
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Abstract
Background: Removing inaccurate penicillin allergy labels (PALs) can reduce unnecessary exposure to 'watch' and 'reserve' groups of antibiotics and thereby reduce antimicrobial resistance. The most efficient model for a non-allergy-specialist-led penicillin allergy de-labelling (PADL) service has not been established.
Objective: To determine the costs to the UK National Health Service of a direct oral penicillin challenge (DPC) for low-risk patients with a PAL in three hospitals in England, each with a different non-allergy-specialist delivery model: pharmacist-led, nurse-led, and mixed multidisciplinary.
Methods: Cost analysis of the DPC pathway, including resources related to staff time and antibiotics. The effect of de-labelling on healthcare utilisation over 5 years was modelled using data from the published literature.
Results: In total, 2257 patients from the Acute Medical or Infectious Disease Unit (AMU/IDU), Pre-surgical, and Haematology-Oncology departments were screened. Subsequently, 126 underwent DPC, and 122 were de-labelled. Twenty-two of these were de-labelled in time to affect their antibiotic regimen; 6 from AMU/IDU and 16 Pre-surgery. The DPC represented 22%-23% of the pathway cost in the pharmacist-led and mixed models, and 15% in the nurse-led model. Across departments and models, the cost per de-labelled patient varied between £577 (95% Credible Interval: 370, 633) for haematology-oncology patients to £2329 (947, 19,504) for AMU/IDU patients, both under the nurse-led model. After 5 years, recouping costs was unlikely for AMU/IDU patients under any model or for all patients combined under the mixed model.
Conclusions: The penicillin allergy de-labelling pathway cost was ≥ 4-fold that of the DPC alone. Costs were up to 3 times higher in an acute compared to an elective setting. No short-term cost savings were identified from proactive or opportunistic penicillin allergy de-labelling in this study.
Citation
Bestwick R, Bhogal R, Kildonaviciute K, Ng BY, Jackson B, Moriarty C, Thomas C, Savic L, Misbah SA, Krishna MT, Mujica-Mota R. An Economic Evaluation of Direct Oral Penicillin Challenge for De-Labelling Low Risk Patients With a Penicillin Allergy Label. Clin Exp Allergy. 2025 May;55(5):378-390. doi: 10.1111/cea.14633. Epub 2025 Feb 5.
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Article