{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:04:42Z","timestamp":1785409482183,"version":"3.56.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1210","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Up to 10% of hospitalized patients in Europe carry a penicillin allergy label, yet most are inaccurate. Mislabelling drives inappropriate broad-spectrum antibiotic use, increased resistance, prolonged admissions, and higher costs. Whilst local and national studies suggest that de-labelling is cost-saving, there has been no EU-wide analysis accounting for cross-country differences in antimicrobial resistance (AMR), costs, and equity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a distributional cost-effectiveness analysis (DCEA) comparing Uniform versus Targeted rollout of penicillin allergy de-labelling across all 27 EU member states. Population data were sourced from Eurostat (2025) and AMR indices from ECDC EARS-Net (2023). Conservative estimates of prevalence, de-labelling effectiveness, QALY gains, and cost savings were drawn from published literature. Outcomes included incremental QALYs, costs, net health benefit (NHB), equity-weighted NHB (ENHB), and equally distributed equivalent (EDE) QALYs. Probabilistic sensitivity analysis (n\u2009=\u20091000) assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both strategies were dominant (health-gaining and cost-saving). Uniform rollout yielded 331\u2009318 QALYs and \u20ac1.44 billion in savings, whilst Targeted delivered 355\u2009561 QALYs and \u20ac1.54 billion, an incremental gain of 24\u2009243 QALYs and \u20ac105 million. Benefits correlated strongly with AMR burden (r\u2009=\u20090.839). Country-level analysis revealed 2.1-fold variation in equity benefits, with the highest gains in Southern and Eastern European countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Penicillin allergy de-labelling is a cost-saving, equity-promoting strategy across the EU. Targeted rollout offers superior efficiency and fairness, particularly in high-AMR countries, and should be prioritized for implementation.<\/jats:p>\n                    <jats:p>Key messages What is already known on this topic: Penicillin allergy labels are common but mostly inaccurate, leading to broader-spectrum antibiotic use, higher costs, and increased antimicrobial resistance. De-labelling is known to be clinically safe and cost-saving in local and national studies. EU-wide evidence incorporating equity and antimicrobial resistance burden has been lacking. What this study adds: This study provides the first EU-wide distributional cost-effectiveness analysis of penicillin allergy de-labelling. Both Uniform and Targeted rollout strategies are cost-saving and health-improving across all EU member states. Targeted implementation yields additional efficiency and equity gains, especially in high-AMR countries. How this study might affect research, practice or policy: Penicillin allergy de-labelling should be prioritized as a core EU antimicrobial stewardship strategy. Targeted rollout can maximize health gains and equity in high-burden settings. These results support EU-level investment and coordinated implementation of de-labelling programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/postmj\/qgag047","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:50:48Z","timestamp":1774443048000},"page":"754-761","source":"Crossref","is-referenced-by-count":0,"title":["Penicillin allergy de-labelling as an equity-promoting intervention in Europe: results from a distributional cost-effectiveness model"],"prefix":"10.1093","volume":"102","author":[{"given":"Iva","family":"Mikulic","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Clinical Pharmacology, Clinical Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Likic","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Clinical Pharmacology, Clinical Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000 ,","place":["Croatia"]},{"name":"University of Zagreb Medical School, Salata 3, Zagreb, 10000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026073006220705500_ref1","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/all.13848","article-title":"The challenge of de-labeling penicillin allergy","volume":"75","author":"Stone","year":"2020","journal-title":"Allergy."},{"key":"2026073006220705500_ref2","doi-asserted-by":"publisher","first-page":"dlaa123","DOI":"10.1093\/jacamr\/dlaa123","article-title":"Safety and efficacy of de-labelling penicillin allergy in adults using direct oral challenge: a systematic review","volume":"3","author":"Cooper","year":"2021","journal-title":"JAC Antimicrob 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