{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:33:38Z","timestamp":1787135618261,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Removing inaccurate penicillin allergy labels (PALs) can reduce unnecessary exposure to \u2018watch\u2019 and \u2018reserve\u2019 groups of antibiotics and thereby reduce antimicrobial resistance. The most efficient model for a non\u2010allergy\u2010specialist\u2010led penicillin allergy de\u2010labelling (PADL) service has not been established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the costs to the UK National Health Service of a direct oral penicillin challenge (DPC) for low\u2010risk patients with a PAL in three hospitals in England, each with a different non\u2010allergy\u2010specialist delivery model: pharmacist\u2010led, nurse\u2010led, and mixed multidisciplinary.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cost analysis of the DPC pathway, including resources related to staff time and antibiotics. The effect of de\u2010labelling on healthcare utilisation over 5\u2009years was modelled using data from the published literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 2257 patients from the Acute Medical or Infectious Disease Unit (AMU\/IDU), Pre\u2010surgical, and Haematology\u2010Oncology departments were screened. Subsequently, 126 underwent DPC, and 122 were de\u2010labelled. Twenty\u2010two of these were de\u2010labelled in time to affect their antibiotic regimen; 6 from AMU\/IDU and 16 Pre\u2010surgery. The DPC represented 22%\u201323% of the pathway cost in the pharmacist\u2010led and mixed models, and 15% in the nurse\u2010led model. Across departments and models, the cost per de\u2010labelled patient varied between \u00a3577 (95% Credible Interval: 370, 633) for haematology\u2010oncology patients to \u00a32329 (947, 19,504) for AMU\/IDU patients, both under the nurse\u2010led model. After 5\u2009years, recouping costs was unlikely for AMU\/IDU patients under any model or for all patients combined under the mixed model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The penicillin allergy de\u2010labelling pathway cost was \u2009\u2265\u20094\u2010fold that of the DPC alone. Costs were up to 3 times higher in an acute compared to an elective setting. No short\u2010term cost savings were identified from proactive or opportunistic penicillin allergy de\u2010labelling in this study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.14633","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T01:07:01Z","timestamp":1738804021000},"page":"378-390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["An Economic Evaluation of Direct Oral Penicillin Challenge for De\u2010Labelling Low Risk Patients With a Penicillin Allergy Label"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3844-6587","authenticated-orcid":false,"given":"R.","family":"Bestwick","sequence":"first","affiliation":[{"name":"Academic Unit of Health Economics Leeds Institute of Health Sciences, University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Bhogal","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kildonaviciute","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9955-1561","authenticated-orcid":false,"given":"B. 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